|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| 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 |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| 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 |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| 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 |
$2,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| 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 |
$3,238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,442.64
|
| 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 REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| 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 |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| 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 |
$2,672.84
|
| 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 |
$249.74
|
| 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 |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| 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 |
$3,238.50
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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 RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.21 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Adventist Health Commercial |
$570.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,959.32
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,930.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,930.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$2,139.00
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.21 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$570.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,959.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,568.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,853.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,424.20
|
| Rate for Payer: Dignity Health Senior |
$2,424.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,711.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,765.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,765.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,374.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$2,139.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,424.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,424.20
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,356.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,618.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,295.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,767.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,531.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,002.60
|
| Rate for Payer: Dignity Health Senior |
$2,002.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,413.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,458.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,135.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.00
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,002.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,002.60
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,356.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,618.57
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,595.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,595.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.00
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
906820208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,728.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,936.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,616.65
|
| 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 |
$5,348.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$532.26
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,564.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,160.25
|
| 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 |
$6,480.75
|
| 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 RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
906820208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,564.02 |
| Max. Negotiated Rate |
$6,480.75 |
| Rate for Payer: Adventist Health Commercial |
$1,728.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,936.37
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,849.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5,849.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,160.25
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$10,117.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,576.05
|
| 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 |
$6,262.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$532.26
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,831.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| 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 |
$7,587.75
|
| 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 RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$10,117.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,831.18 |
| Max. Negotiated Rate |
$7,587.75 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,849.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,849.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$10,117.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,576.05
|
| 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 |
$6,262.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,831.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| 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 |
$7,587.75
|
| 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 RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,642.58 |
| Max. Negotiated Rate |
$6,806.25 |
| Rate for Payer: Adventist Health Commercial |
$1,815.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,234.52
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,143.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,143.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.75
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$10,117.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,831.18 |
| Max. Negotiated Rate |
$7,587.75 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,849.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,849.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,815.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,234.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,898.75
|
| 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 |
$5,617.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,642.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.75
|
| 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 |
$6,806.25
|
| 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 RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.62 |
| Max. Negotiated Rate |
$1,767.75 |
| Rate for Payer: Adventist Health Commercial |
$471.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.26
|
| Rate for Payer: Cash Price |
$1,060.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,595.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,595.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.25
|
| Rate for Payer: Multiplan Commercial |
$1,767.75
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
OP
|
$2,357.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$471.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,060.65
|
| Rate for Payer: Cash Price |
$1,060.65
|
| Rate for Payer: Cash Price |
$1,060.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,532.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,767.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
OP
|
$3,537.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,429.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,299.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,189.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
IP
|
$3,537.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$640.20 |
| Max. Negotiated Rate |
$2,652.75 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,429.92
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,394.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,394.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.25
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
IP
|
$1,605.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$1,203.75 |
| Rate for Payer: Adventist Health Commercial |
$321.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,102.64
|
| Rate for Payer: Cash Price |
$722.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$1,203.75
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
OP
|
$1,605.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$1,309.63 |
| Rate for Payer: Adventist Health Commercial |
$321.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$512.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,102.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.90
|
| Rate for Payer: Blue Shield of California Commercial |
$254.95
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$722.25
|
| Rate for Payer: Cash Price |
$722.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,043.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,043.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$993.50
|
| Rate for Payer: Heritage Provider Network Senior |
$993.50
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$1,203.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC RENAL DILATOR SET
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$443.39
|
| Rate for Payer: Blue Shield of California EPN |
$419.12
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.90
|
| Rate for Payer: Dignity Health Senior |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.58
|
| Rate for Payer: Heritage Provider Network Senior |
$330.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
HC RENAL DILATOR SET
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.38
|
| Rate for Payer: Heritage Provider Network Senior |
$483.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.55
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.64
|
| Rate for Payer: Blue Shield of California Commercial |
$67.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.01
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$390.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Senior |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$371.40
|
| Rate for Payer: Heritage Provider Network Senior |
$371.40
|
| Rate for Payer: Humana Medicare |
$8.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.94
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.20
|
| Rate for Payer: Heritage Provider Network Senior |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
|
