|
HC MICROCATHETER
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$625.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Blue Shield of California Commercial |
$713.70
|
| Rate for Payer: Blue Shield of California EPN |
$570.96
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Senior |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC MICROCATHETER
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC MICROCATH MAGIC
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,560.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.16
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,402.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH MAGIC
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,560.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.16
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,095.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,402.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,285.00
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,560.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.16
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,402.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC MICROCATH MAGIC FLOW
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909091887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,862.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,560.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.16
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,785.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,095.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,402.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,285.00
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,710.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,432.33
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,638.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,649.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,649.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,781.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.75
|
| Rate for Payer: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,287.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,179.71
|
|
|
HC MICROCATH NAVIEN
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,710.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,447.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,959.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,672.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,432.33
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cash Price |
$1,959.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,638.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,028.55
|
| Rate for Payer: Dignity Health Senior |
$3,028.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,280.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,649.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,649.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,781.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,494.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,494.10
|
| Rate for Payer: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,287.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,179.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,028.55
|
|
|
HC MICROCATH ORION
|
Facility
|
IP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$842.74 |
| Max. Negotiated Rate |
$3,492.00 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Cash Price |
$2,560.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,152.11
|
| Rate for Payer: Heritage Provider Network Senior |
$3,152.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$3,492.00
|
|
|
HC MICROCATH ORION
|
Facility
|
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$842.74 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,488.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,198.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,560.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,840.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.13
|
| Rate for Payer: Cash Price |
$2,560.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,026.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,957.60
|
| Rate for Payer: Dignity Health Senior |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,882.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,882.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,220.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.20
|
| Rate for Payer: Multiplan Commercial |
$3,492.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,328.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,957.60
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.49 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,938.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,491.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,994.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,720.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,212.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,769.98
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,357.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,082.95
|
| Rate for Payer: Dignity Health Senior |
$3,082.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,357.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,245.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,245.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,730.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,538.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,538.90
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,813.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,813.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.95
|
|
|
HC MICRO CATH, PENUMBRA
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.49 |
| Max. Negotiated Rate |
$2,720.25 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,455.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.76 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,582.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,033.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,805.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,444.48
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,924.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: Dignity Health Senior |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,832.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,832.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,411.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,480.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,480.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC MICROCATH PHENOM 17
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.76 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,003.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,003.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
|
|
HC MICROCATH SOFIA HEADWAY
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC MICROCATH SOFIA HEADWAY
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909041887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
|
|
HC MICROCATH SWIFT NINJA
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC MICROCATH SWIFT NINJA
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.87 |
| Max. Negotiated Rate |
$2,121.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,914.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,914.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
|
|
HC MICROCATH TREVO PRO
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.87 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,511.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,725.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,380.06
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,838.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Senior |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,838.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,750.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,750.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,348.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,414.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
HC MICRO EXAM/CRYSTALS
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.21
|
| Rate for Payer: Blue Shield of California Commercial |
$57.54
|
| Rate for Payer: Blue Shield of California EPN |
$46.15
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$123.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.06
|
| Rate for Payer: Dignity Health Senior |
$7.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.61
|
| Rate for Payer: Heritage Provider Network Senior |
$117.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Vantage Medical Group Senior |
$7.33
|
|
|
HC MICRO EXAM/CRYSTALS
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC MICRO EXAM/SPERM
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.96
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$88.55
|
| Rate for Payer: Cash Price |
$88.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.66
|
| Rate for Payer: Heritage Provider Network Senior |
$99.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC MICRO EXAM/SPERM
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$88.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
