|
HC MICROALBUMIN URINE RANDOM
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$48.46 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.46
|
| Rate for Payer: Blue Shield of California Commercial |
$45.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.35
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: IEHP Medi-Cal |
$7.92
|
| Rate for Payer: IEHP Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROCATH DIREXION
|
Facility
IP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.14 |
| Max. Negotiated Rate |
$2,292.00 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,099.47
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,068.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,068.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
|
|
HC MICROCATH DIREXION
|
Facility
OP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,099.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,680.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,292.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,897.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,793.87
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,986.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,597.60
|
| Rate for Payer: Dignity Health Senior |
$2,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,891.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,891.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,472.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,597.60
|
|
|
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: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Cash Price |
$526.50
|
| 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 MICROCATHETER
|
Facility
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Blue Shield of California Commercial |
$726.57
|
| Rate for Payer: Blue Shield of California EPN |
$686.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| 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 |
$563.94
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.15
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| 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: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| 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 |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| 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 |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| 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 |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| 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 |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.15
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| 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: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,415.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,296.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,028.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,959.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,672.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,212.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,091.48
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cash Price |
$1,603.35
|
| 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: Multiplan Commercial |
$2,672.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,299.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,028.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,028.55
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,603.35
|
| Rate for Payer: Cash Price |
$1,603.35
|
| 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 |
$2,412.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,412.15
|
| 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 |
$1,299.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,190.40
|
|
|
HC MICROCATH ORION
|
Facility
OP
|
$4,656.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$3,957.60 |
| Rate for Payer: Adventist Health Commercial |
$931.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,198.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,957.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,560.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,492.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,891.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,733.07
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| 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 |
$2,244.19
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,957.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,957.60
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,198.67
|
| Rate for Payer: Cash Price |
$2,095.20
|
| 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 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: Aetna of CA Non-Gatekeeper |
$2,491.75
|
| Rate for Payer: Cash Price |
$1,632.15
|
| 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 MICRO CATH, PENUMBRA
|
Facility
OP
|
$3,627.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,491.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,082.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,994.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,720.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,252.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,129.05
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cash Price |
$1,632.15
|
| 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 |
$1,748.21
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,082.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,082.95
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,033.52
|
| Rate for Payer: Cash Price |
$1,332.00
|
| 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 PHENOM 17
|
Facility
OP
|
$2,960.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,033.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,838.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,737.52
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| 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 |
$1,426.72
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,861.62
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| 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: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| 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 |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| 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 |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,861.62
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| 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: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| 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 |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| 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 |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
|
|
HC MICROCATH TREVO PRO
|
Facility
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,756.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,660.04
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| 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 |
$1,363.10
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,942.84
|
| Rate for Payer: Cash Price |
$1,272.60
|
| 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 MICRO EXAM/CRYSTALS
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$59.79 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.79
|
| Rate for Payer: Blue Shield of California Commercial |
$55.84
|
| Rate for Payer: Blue Shield of California EPN |
$43.66
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.06
|
| Rate for Payer: Dignity Health Senior |
$7.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Humana Medicare |
$7.33
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| 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 |
$20.25
|
| 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 |
$11.00
|
| 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
|
$194.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
