|
HC MICROCATH MAGIC
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,247.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,864.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.17
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO |
$2,716.70
|
| Rate for Payer: Cigna of CA PPO |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$1,940.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,456.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,417.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,387.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,271.03
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cigna of CA HMO |
$2,494.10
|
| Rate for Payer: Cigna of CA PPO |
$2,494.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,425.20
|
| Rate for Payer: Galaxy Health WC |
$3,028.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,376.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,205.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.12
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: Networks By Design Commercial |
$1,781.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,028.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,337.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1,273.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,166.88
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$3,028.55 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,959.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,672.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,063.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,629.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,731.62
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cigna of CA HMO |
$2,494.10
|
| Rate for Payer: Cigna of CA PPO |
$2,494.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,028.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,028.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,425.20
|
| Rate for Payer: Galaxy Health WC |
$3,028.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,376.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,205.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,494.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,494.10
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: Networks By Design Commercial |
$1,781.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,028.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,337.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1,273.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,166.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,028.55
|
|
|
HC MICROCATH ORION
|
Facility
|
IP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.20 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.40
|
| Rate for Payer: Galaxy Health WC |
$3,957.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,793.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,105.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,773.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.44
|
| Rate for Payer: Multiplan Commercial |
$3,724.80
|
| Rate for Payer: Networks By Design Commercial |
$3,026.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,957.60
|
|
|
HC MICROCATH ORION
|
Facility
|
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.20 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,053.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,560.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,859.25
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cigna of CA HMO |
$2,979.84
|
| Rate for Payer: Cigna of CA PPO |
$3,445.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,957.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.40
|
| Rate for Payer: Galaxy Health WC |
$3,957.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,793.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,105.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,773.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.20
|
| Rate for Payer: Multiplan Commercial |
$3,724.80
|
| Rate for Payer: Networks By Design Commercial |
$3,026.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,957.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,793.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,793.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,957.60
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.80
|
| Rate for Payer: Galaxy Health WC |
$3,082.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.48
|
| Rate for Payer: Multiplan Commercial |
$2,901.60
|
| Rate for Payer: Networks By Design Commercial |
$2,357.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.95
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Vantage Medical Group Senior |
$3,082.95
|
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,378.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,720.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,227.34
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cigna of CA HMO |
$2,321.28
|
| Rate for Payer: Cigna of CA PPO |
$2,683.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,082.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,450.80
|
| Rate for Payer: Galaxy Health WC |
$3,082.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,381.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,538.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,538.90
|
| Rate for Payer: Multiplan Commercial |
$2,901.60
|
| Rate for Payer: Networks By Design Commercial |
$2,357.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,082.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,176.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,813.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,813.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,813.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.95
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,924.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,941.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,817.74
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of CA HMO |
$1,894.40
|
| Rate for Payer: Cigna of CA PPO |
$2,190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,924.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,480.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC MICROCATH SOFIA HEADWAY
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,823.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,597.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,369.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC MICROCATH SOFIA HEADWAY
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
|
|
HC MICROCATH SWIFT NINJA
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
|
|
HC MICROCATH SWIFT NINJA
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,823.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,597.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,369.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,854.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,736.67
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna of CA HMO |
$1,809.92
|
| Rate for Payer: Cigna of CA PPO |
$2,092.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
|
|
HC MICRO EXAM/CRYSTALS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$70.55 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.55
|
| Rate for Payer: Blue Shield of California Commercial |
$20.74
|
| Rate for Payer: Blue Shield of California EPN |
$13.70
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: EPIC Health Plan Senior |
$7.33
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.94
|
| Rate for Payer: United Healthcare All Other HMO |
$5.94
|
| Rate for Payer: United Healthcare HMO Rider |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Vantage Medical Group Senior |
$7.33
|
|
|
HC MICRO EXAM/CRYSTALS
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC MICRO EXAM/SPERM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$118.96 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.96
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC MICRO EXAM/SPERM
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$136.85 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: EPIC Health Plan Senior |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC MICROFIL LARVA
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MICROFIL LARVA
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.18
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
