|
HC METANEPHRINE URINE RANDOM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.84
|
| Rate for Payer: Blue Shield of California Commercial |
$132.32
|
| Rate for Payer: Blue Shield of California EPN |
$103.44
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.24
|
| Rate for Payer: Heritage Provider Network Senior |
$40.24
|
| Rate for Payer: Humana Medicare |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$215.61 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$215.61
|
| Rate for Payer: Blue Shield of California EPN |
$168.55
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$38.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| Rate for Payer: Blue Shield of California Commercial |
$141.59
|
| Rate for Payer: Blue Shield of California EPN |
$133.84
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Senior |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.13
|
| Rate for Payer: Heritage Provider Network Senior |
$141.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.36
|
| Rate for Payer: Heritage Provider Network Senior |
$154.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$336.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.94
|
| Rate for Payer: Blue Shield of California EPN |
$412.07
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Senior |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.03
|
| Rate for Payer: Heritage Provider Network Senior |
$325.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$351.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$255.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$234.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$336.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$475.25
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$351.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$255.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$234.54
|
|
|
HC MICROALBUMIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$48.46 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.46
|
| Rate for Payer: Blue Shield of California Commercial |
$45.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.35
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC MICROALBUMIN URINE 24 HOURS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$48.46 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.46
|
| Rate for Payer: Blue Shield of California Commercial |
$45.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.35
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN URINE 24 HOURS
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC MICROALBUMIN URINE RANDOM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC MICROALBUMIN URINE RANDOM
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$48.46 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.46
|
| Rate for Payer: Blue Shield of California Commercial |
$45.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.35
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROCATH DIREXION
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.14 |
| Max. Negotiated Rate |
$2,292.00 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,099.47
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,068.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,068.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
|
|
HC MICROCATH DIREXION
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,099.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,292.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,897.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,793.87
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,986.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,597.60
|
| Rate for Payer: Dignity Health Senior |
$2,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,891.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,891.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,472.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,597.60
|
|
|
HC MICROCATHETER
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC MICROCATHETER
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Blue Shield of California Commercial |
$726.57
|
| Rate for Payer: Blue Shield of California EPN |
$686.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Senior |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$563.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,095.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
|
|
HC MICROCATH MAGIC
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| 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 |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.15
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| 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 Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
| 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
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| 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 |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.15
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| 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 Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
| 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,095.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,710.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,447.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,638.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,412.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,412.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,781.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.75
|
| Rate for Payer: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,299.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,190.40
|
|
|
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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,710.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,447.78
|
| 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 |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,212.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,091.48
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,638.98
|
| 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 Senior |
$3,028.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,280.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,649.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,649.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,781.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.75
|
| Rate for Payer: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,299.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,190.40
|
| 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
|
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,198.67
|
| 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: Blue Shield of California Commercial |
$2,891.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,733.07
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,026.40
|
| 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 Senior |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,882.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,882.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,244.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$3,492.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,957.60
|
|
|
HC MICROCATH ORION
|
Facility
|
IP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$842.74 |
| Max. Negotiated Rate |
$3,492.00 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,198.67
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,152.11
|
| Rate for Payer: Heritage Provider Network Senior |
$3,152.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$3,492.00
|
|
