|
HC SELECT WND DEBRIDE GT 20 SQ CM PT
|
Facility
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900411301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: 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 |
900411301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$828.75 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.08
|
| Rate for Payer: Heritage Provider Network Senior |
$748.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.25
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: 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 |
$337.20
|
| Rate for Payer: Blue Shield of California EPN |
$318.74
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.12
|
| Rate for Payer: Heritage Provider Network Senior |
$336.12
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: 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 |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$275.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: 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 |
$1,756.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$197.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: 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 LT 20 SQ CM COM
|
Facility
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.73
|
| Rate for Payer: Heritage Provider Network Senior |
$637.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
901300070
|
|
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 DEBRIDE LT 20 SQ CM MCAL
|
Facility
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
901300070
|
|
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 DEBRIDE LT 20 SQ CM MCAL
|
Facility
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.15
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.73
|
| Rate for Payer: Heritage Provider Network Senior |
$637.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400058
|
|
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 LT 20 SQ CM PT
|
Facility
OP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900411300
|
|
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 LT 20 SQ CM PT
|
Facility
IP
|
$942.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900411300
|
|
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 SELF CARE/HOME MGT TRNG 15 MIN MCAL
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
901300066
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.31
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.70
|
| Rate for Payer: Heritage Provider Network Senior |
$176.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN MCAL
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
901300066
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.75
|
| 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 |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.85
|
| Rate for Payer: Dignity Health Senior |
$221.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.56
|
| Rate for Payer: Heritage Provider Network Senior |
$161.56
|
| Rate for Payer: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| 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 |
$221.85
|
| Rate for Payer: Vantage Medical Group Senior |
$221.85
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN OT
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
905104363
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$135.00
|
| 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 |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Senior |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| 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 Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN OT
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
905104363
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.86
|
| Rate for Payer: Heritage Provider Network Senior |
$121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN PT
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
900419056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.86
|
| Rate for Payer: Heritage Provider Network Senior |
$121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN PT
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
900419056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$135.00
|
| 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 |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Senior |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| 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 Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SELLA TURCICA
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
909001114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.77
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$184.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.80
|
| Rate for Payer: Heritage Provider Network Senior |
$175.80
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$33.73
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SELLA TURCICA
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
909001114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.11
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.27
|
| Rate for Payer: Heritage Provider Network Senior |
$192.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
|
|
HC SEMEN ANALYSIS
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
900910151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.92
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.86
|
| Rate for Payer: Heritage Provider Network Senior |
$274.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
|
|
HC SEMEN ANALYSIS
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
900910151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.38
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.54
|
| Rate for Payer: Dignity Health Senior |
$12.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Humana Medicare |
$12.31
|
| Rate for Payer: IEHP Medicare Advantage |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.51
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$12.31
|
|
|
HC SENSITIVITY DISK DIFFUSION
|
Facility
IP
|
$319.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
