|
HC IUD REMOVAL
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC IUD REMOVAL
|
Facility
OP
|
$627.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC IUD REMOVAL
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC IVC FILTER REPOSITION
|
Facility
OP
|
$17,944.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$473.41 |
| Max. Negotiated Rate |
$13,458.00 |
| Rate for Payer: Adventist Health Commercial |
$3,588.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,327.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$8,074.80
|
| Rate for Payer: Cash Price |
$8,074.80
|
| Rate for Payer: Cash Price |
$8,074.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,663.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,107.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$473.41
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,247.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$13,458.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IVC FILTER REPOSITION
|
Facility
IP
|
$17,944.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,247.86 |
| Max. Negotiated Rate |
$13,458.00 |
| Rate for Payer: Adventist Health Commercial |
$3,588.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,327.53
|
| Rate for Payer: Cash Price |
$8,074.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,148.09
|
| Rate for Payer: Heritage Provider Network Senior |
$12,148.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,247.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,486.00
|
| Rate for Payer: Multiplan Commercial |
$13,458.00
|
|
|
HC IVC FILTER REPOSITION
|
Facility
IP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,487.12 |
| Max. Negotiated Rate |
$10,305.75 |
| Rate for Payer: Adventist Health Commercial |
$2,748.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,440.07
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,302.66
|
| Rate for Payer: Heritage Provider Network Senior |
$9,302.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,487.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,435.25
|
| Rate for Payer: Multiplan Commercial |
$10,305.75
|
|
|
HC IVC FILTER REPOSITION
|
Facility
OP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$473.41 |
| Max. Negotiated Rate |
$10,305.75 |
| Rate for Payer: Adventist Health Commercial |
$2,748.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,440.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$6,183.45
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,931.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,505.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$473.41
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,487.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$10,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
IP
|
$10,779.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.00 |
| Max. Negotiated Rate |
$8,084.25 |
| Rate for Payer: Adventist Health Commercial |
$2,155.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,405.17
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,297.38
|
| Rate for Payer: Heritage Provider Network Senior |
$7,297.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,694.75
|
| Rate for Payer: Multiplan Commercial |
$8,084.25
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
OP
|
$11,962.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,392.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,217.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$5,382.90
|
| Rate for Payer: Cash Price |
$5,382.90
|
| Rate for Payer: Cash Price |
$5,382.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,775.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,404.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$472.91
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,165.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,990.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$8,971.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
IP
|
$11,962.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,165.12 |
| Max. Negotiated Rate |
$8,971.50 |
| Rate for Payer: Adventist Health Commercial |
$2,392.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,217.89
|
| Rate for Payer: Cash Price |
$5,382.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,098.27
|
| Rate for Payer: Heritage Provider Network Senior |
$8,098.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,165.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,990.50
|
| Rate for Payer: Multiplan Commercial |
$8,971.50
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
OP
|
$10,779.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,155.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,405.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$4,850.55
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,006.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,672.20
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$472.91
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,694.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$8,084.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
IP
|
$666.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
IP
|
$666.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
OP
|
$666.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: Dignity Health Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Humana Medicare |
$88.02
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$321.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110.91
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
OP
|
$666.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: Dignity Health Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.25
|
| Rate for Payer: Heritage Provider Network Senior |
$412.25
|
| Rate for Payer: Humana Medicare |
$88.02
|
| Rate for Payer: IEHP Medi-Cal |
$48.44
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$167.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110.91
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.82
|
| Rate for Payer: TriValley Medical Group Senior |
$88.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$392.25 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.30
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.07
|
| Rate for Payer: Heritage Provider Network Senior |
$354.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.75
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$339.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Senior |
$444.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$323.74
|
| Rate for Payer: Heritage Provider Network Senior |
$323.74
|
| Rate for Payer: IEHP Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$252.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.75
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$392.25 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.30
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.07
|
| Rate for Payer: Heritage Provider Network Senior |
$354.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.75
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$339.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Senior |
$444.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.07
|
| Rate for Payer: Heritage Provider Network Senior |
$354.07
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$252.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.75
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$713.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.66
|
| Rate for Payer: Heritage Provider Network Senior |
$679.66
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$97.66
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.35
|
| Rate for Payer: Heritage Provider Network Senior |
$743.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.35
|
| Rate for Payer: Heritage Provider Network Senior |
$743.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$713.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.66
|
| Rate for Payer: Heritage Provider Network Senior |
$679.66
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$97.66
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV INFUS THER/PROP/DIA/INIT HR
|
Facility
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.35
|
| Rate for Payer: Heritage Provider Network Senior |
$743.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC IV INFUS THER/PROP/DIA/INIT HR
|
Facility
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$713.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.66
|
| Rate for Payer: Heritage Provider Network Senior |
$679.66
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$97.66
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
