|
HC PICC KIT SINGLE LUMEN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$187.54
|
| Rate for Payer: Blue Shield of California EPN |
$177.27
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.70
|
| Rate for Payer: Dignity Health Senior |
$256.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.83
|
| Rate for Payer: Heritage Provider Network Senior |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$110.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.70
|
| Rate for Payer: Vantage Medical Group Senior |
$256.70
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.45
|
| Rate for Payer: Heritage Provider Network Senior |
$204.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$110.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.90
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$687.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,362.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,235.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,128.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,579.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$622.46 |
| Max. Negotiated Rate |
$2,579.25 |
| Rate for Payer: Adventist Health Commercial |
$687.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,362.59
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,328.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,328.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.75
|
| Rate for Payer: Multiplan Commercial |
$2,579.25
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$622.46 |
| Max. Negotiated Rate |
$2,579.25 |
| Rate for Payer: Adventist Health Commercial |
$687.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,362.59
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,328.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,328.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.75
|
| Rate for Payer: Multiplan Commercial |
$2,579.25
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$622.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$687.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,362.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Cash Price |
$1,547.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,235.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,328.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,328.20
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,657.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,579.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,248.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,148.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$5,158.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$933.60 |
| Max. Negotiated Rate |
$3,868.50 |
| Rate for Payer: Adventist Health Commercial |
$1,031.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,543.55
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,491.97
|
| Rate for Payer: Heritage Provider Network Senior |
$3,491.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$933.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,289.50
|
| Rate for Payer: Multiplan Commercial |
$3,868.50
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$5,158.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,031.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,543.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,203.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,027.75
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,352.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,192.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,192.80
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$933.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,289.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,868.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PID
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC PID
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$338.25 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.33
|
| Rate for Payer: Heritage Provider Network Senior |
$305.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.50
|
| Rate for Payer: Blue Shield of California Commercial |
$280.07
|
| Rate for Payer: Blue Shield of California EPN |
$264.74
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.17
|
| Rate for Payer: Heritage Provider Network Senior |
$279.17
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$160.43 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.43
|
| Rate for Payer: Blue Shield of California Commercial |
$22.36
|
| Rate for Payer: Blue Shield of California EPN |
$21.13
|
| 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 |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Senior |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC PIN WORM PREP
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC PIN WORM PREP
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| 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 |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$17,541.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.18 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,508.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,050.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,401.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,857.88
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$306.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,174.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,385.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$13,155.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.18 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Adventist Health Commercial |
$4,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,740.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$9,000.00
|
| Rate for Payer: Cash Price |
$9,000.00
|
| Rate for Payer: Cash Price |
$9,000.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,380.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$306.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,620.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$17,541.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,174.92 |
| Max. Negotiated Rate |
$13,155.75 |
| Rate for Payer: Adventist Health Commercial |
$3,508.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,050.67
|
| Rate for Payer: Cash Price |
$7,893.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,875.26
|
| Rate for Payer: Heritage Provider Network Senior |
$11,875.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,174.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,385.25
|
| Rate for Payer: Multiplan Commercial |
$13,155.75
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,620.00 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Adventist Health Commercial |
$4,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,740.00
|
| Rate for Payer: Cash Price |
$9,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,540.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,620.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$15,000.00
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$506.68 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$427.48
|
| Rate for Payer: Blue Shield of California Commercial |
$506.68
|
| Rate for Payer: Blue Shield of California EPN |
$396.10
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: Dignity Health Senior |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$98.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Humana Medicare |
$98.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.62
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$98.11
|
| Rate for Payer: TriValley Medical Group Senior |
$98.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.11 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.32
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$587.64
|
| Rate for Payer: Heritage Provider Network Senior |
$587.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$572.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$589.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$803.25
|
| Rate for Payer: Blue Shield of California Commercial |
$665.09
|
| Rate for Payer: Blue Shield of California EPN |
$628.68
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$696.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$910.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$910.35
|
| Rate for Payer: Dignity Health Senior |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.95
|
| Rate for Payer: Heritage Provider Network Senior |
$662.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$910.35
|
| Rate for Payer: Vantage Medical Group Senior |
$910.35
|
|
