|
HC IRRADIATION PROCEDURE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.87
|
| Rate for Payer: Blue Shield of California Commercial |
$170.80
|
| Rate for Payer: Blue Shield of California EPN |
$136.64
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$54.86
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$304.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$211.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$479.25 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$87.84
|
| Rate for Payer: Blue Shield of California EPN |
$70.27
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.14
|
| Rate for Payer: Heritage Provider Network Senior |
$89.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.02
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$526.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.49
|
| Rate for Payer: Heritage Provider Network Senior |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$189.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.43
|
| Rate for Payer: Blue Shield of California Commercial |
$216.55
|
| Rate for Payer: Blue Shield of California EPN |
$173.24
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.75
|
| Rate for Payer: Heritage Provider Network Senior |
$219.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.32
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.34
|
| Rate for Payer: Heritage Provider Network Senior |
$240.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.75
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
|
|
HC IUD INSERTION
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$662.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$530.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$723.00
|
| Rate for Payer: Blue Shield of California Commercial |
$588.04
|
| Rate for Payer: Blue Shield of California EPN |
$470.43
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$819.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$819.40
|
| Rate for Payer: Dignity Health Senior |
$819.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.72
|
| Rate for Payer: Heritage Provider Network Senior |
$596.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$459.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.80
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$482.00
|
| Rate for Payer: TriValley Medical Group Senior |
$482.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$482.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$482.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$819.40
|
| Rate for Payer: Vantage Medical Group Senior |
$819.40
|
|
|
HC IUD INSERTION
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.48 |
| Max. Negotiated Rate |
$723.00 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.63
|
| Rate for Payer: Heritage Provider Network Senior |
$652.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.00
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.85
|
| Rate for Payer: Blue Shield of California EPN |
$334.28
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.01
|
| Rate for Payer: Heritage Provider Network Senior |
$424.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$342.50
|
| Rate for Payer: TriValley Medical Group Senior |
$342.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$342.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$342.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,054.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,362.77 |
| Max. Negotiated Rate |
$9,790.50 |
| Rate for Payer: Adventist Health Commercial |
$2,610.80
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,837.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8,837.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,362.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,263.50
|
| Rate for Payer: Multiplan Commercial |
$9,790.50
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$11,096.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,008.38 |
| Max. Negotiated Rate |
$8,322.00 |
| Rate for Payer: Adventist Health Commercial |
$2,219.20
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,511.99
|
| Rate for Payer: Heritage Provider Network Senior |
$7,511.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,008.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,774.00
|
| Rate for Payer: Multiplan Commercial |
$8,322.00
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$11,096.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,219.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,622.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Cash Price |
$4,993.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,212.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,868.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$491.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,008.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,774.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$8,322.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,054.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,610.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,968.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,485.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,080.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$491.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,362.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,263.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$9,790.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$10,240.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,853.44 |
| Max. Negotiated Rate |
$7,680.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.00
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,932.48
|
| Rate for Payer: Heritage Provider Network Senior |
$6,932.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,853.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,560.00
|
| Rate for Payer: Multiplan Commercial |
$7,680.00
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$8,704.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,740.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,979.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,657.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,387.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$490.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,176.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$10,240.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,034.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,656.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,338.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$490.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,853.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,560.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$7,680.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$8,704.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,575.42 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Adventist Health Commercial |
$1,740.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,892.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5,892.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,176.00
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$407.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$523.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Senior |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.68
|
| Rate for Payer: Heritage Provider Network Senior |
$471.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$363.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.94
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.47
|
| Rate for Payer: TriValley Medical Group Senior |
$90.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$407.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$523.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Senior |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.87
|
| Rate for Payer: Heritage Provider Network Senior |
$515.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$363.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.94
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$252.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.87
|
| Rate for Payer: Heritage Provider Network Senior |
$515.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
|
