|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.86
|
| Rate for Payer: Blue Shield of California Commercial |
$21.07
|
| Rate for Payer: Blue Shield of California EPN |
$16.47
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: Dignity Health Senior |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Humana Medicare |
$2.70
|
| Rate for Payer: IEHP Medi-Cal |
$3.74
|
| Rate for Payer: IEHP Medicare Advantage |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
IP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.21
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.91
|
| Rate for Payer: Heritage Provider Network Senior |
$561.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
OP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$443.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$456.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$622.50
|
| Rate for Payer: Blue Shield of California Commercial |
$515.43
|
| Rate for Payer: Blue Shield of California EPN |
$487.21
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$539.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.50
|
| Rate for Payer: Dignity Health Senior |
$705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.77
|
| Rate for Payer: Heritage Provider Network Senior |
$513.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$400.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.50
|
| Rate for Payer: Vantage Medical Group Senior |
$705.50
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
OP
|
$584.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
906820171
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$151.59
|
| 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 CATH L/R PULMONARY ART
|
Facility
IP
|
$584.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
906820171
|
|
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 L/R PULMONARY ART
|
Facility
OP
|
$1,926.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,323.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,637.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,059.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,444.50
|
| 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 |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,251.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,637.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,637.10
|
| Rate for Payer: Dignity Health Senior |
$1,637.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.19
|
| Rate for Payer: IEHP Medi-Cal |
$151.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$928.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.50
|
| Rate for Payer: Multiplan Commercial |
$1,444.50
|
| 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 |
$1,637.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,637.10
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
IP
|
$1,926.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.61 |
| Max. Negotiated Rate |
$1,444.50 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,323.16
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.50
|
| Rate for Payer: Multiplan Commercial |
$1,444.50
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: AlphaCare 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: 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 CATH PULMON. ART SEGMENTAL
|
Facility
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$551.69 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Adventist Health Commercial |
$609.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,093.98
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,063.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,063.50
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2,590.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,676.40
|
| Rate for Payer: AlphaCare 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: 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
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 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: 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 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
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 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: 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 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: AlphaCare Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: AlphaCare 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: 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: AlphaCare Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: AlphaCare 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: 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: AlphaCare Medical Group Commercial/Exchange |
$461.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$298.65
|
| Rate for Payer: AlphaCare 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: 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
|
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 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: AlphaCare Medical Group Commercial/Exchange |
$461.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$298.65
|
| Rate for Payer: AlphaCare 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: 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 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: AlphaCare Medical Group Commercial/Exchange |
$939.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: AlphaCare 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: 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
|
|
