|
HC MICRO CATH, PENUMBRA
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.49 |
| Max. Negotiated Rate |
$2,720.25 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,491.75
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,455.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,491.75
|
| 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: Blue Shield of California Commercial |
$2,252.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,129.05
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,357.55
|
| 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 Senior |
$3,082.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,357.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,245.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,245.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,748.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$535.76 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,033.52
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,003.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,003.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,033.52
|
| 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: Blue Shield of California Commercial |
$1,838.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,737.52
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,924.00
|
| 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 Senior |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,832.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,832.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,426.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
|
|
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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| 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 |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,861.62
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| 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 Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| 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 |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,861.62
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| 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 Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.84
|
| 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: Blue Shield of California Commercial |
$1,756.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,660.04
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,838.20
|
| 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 Senior |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,838.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,750.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,750.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,363.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| 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 |
$511.87 |
| Max. Negotiated Rate |
$2,121.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.84
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,914.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,914.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
|
|
HC MICRO EXAM/CRYSTALS
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| 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 MICRO EXAM/CRYSTALS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| 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 |
$59.79
|
| Rate for Payer: Blue Shield of California Commercial |
$55.84
|
| Rate for Payer: Blue Shield of California EPN |
$43.66
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.06
|
| Rate for Payer: Dignity Health Senior |
$7.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Humana Medicare |
$7.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Vantage Medical Group Senior |
$7.33
|
|
|
HC MICRO EXAM/SPERM
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.67
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Senior |
$111.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
|
|
HC MICRO EXAM/SPERM
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$100.81 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$100.81
|
| 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 |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| 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 |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| 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 MICRO EXAM/TRICHOMONAS
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC MICROFIL LARVA
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| 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 |
$50.15
|
| Rate for Payer: Blue Shield of California Commercial |
$46.79
|
| Rate for Payer: Blue Shield of California EPN |
$36.58
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| 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
|
|
|
HC MICROFIL LARVA
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC MICROGLOBULIN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900912121
|
|
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 MICROGLOBULIN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900912121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.47
|
| Rate for Payer: Blue Shield of California Commercial |
$126.39
|
| Rate for Payer: Blue Shield of California EPN |
$98.81
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Senior |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Humana Medicare |
$16.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC MICROGUIDEWIRE
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$445.50
|
| Rate for Payer: Blue Shield of California Commercial |
$368.87
|
| Rate for Payer: Blue Shield of California EPN |
$348.68
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.90
|
| Rate for Payer: Dignity Health Senior |
$504.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.69
|
| Rate for Payer: Heritage Provider Network Senior |
$367.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.90
|
| Rate for Payer: Vantage Medical Group Senior |
$504.90
|
|
|
HC MICROGUIDEWIRE
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.08
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.14
|
| Rate for Payer: Heritage Provider Network Senior |
$402.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$18.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Senior |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6.81
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
