|
HC MFM INIT NUTR ADD. 15 MIN MCAL
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
901046202
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$56.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.03
|
| Rate for Payer: Blue Shield of California Commercial |
$84.18
|
| Rate for Payer: Blue Shield of California EPN |
$67.34
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC MFM INIT NUTR EVAL 30 MIN MCAL
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
901046200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$56.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.03
|
| Rate for Payer: Blue Shield of California Commercial |
$84.18
|
| Rate for Payer: Blue Shield of California EPN |
$67.34
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC MFM INIT NUTR EVAL 30 MIN MCAL
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
901046200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.87
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC MFM NUTR GRP EA. 15 MIN MCAL
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
901046412
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.54
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC MFM NUTR GRP EA. 15 MIN MCAL
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
901046412
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$14.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.51
|
| Rate for Payer: Blue Shield of California Commercial |
$21.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.08
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$146.83
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.36
|
| Rate for Payer: Heritage Provider Network Senior |
$154.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
|
|
HC MIC GASTRO ENTERIC TUBE
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
909081720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.05
|
| Rate for Payer: Blue Shield of California Commercial |
$139.08
|
| Rate for Payer: Blue Shield of California EPN |
$111.26
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.13
|
| Rate for Payer: Heritage Provider Network Senior |
$141.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$108.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$114.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$114.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$287.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$433.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$282.20
|
| Rate for Payer: Blue Shield of California EPN |
$282.20
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.03
|
| Rate for Payer: Heritage Provider Network Senior |
$325.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$351.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$232.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC MIC GASTRO J TUBE
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909081722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$282.20
|
| Rate for Payer: Blue Shield of California EPN |
$282.20
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.03
|
| Rate for Payer: Heritage Provider Network Senior |
$325.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$351.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$232.43
|
|
|
HC MICROALBUMIN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC MICROALBUMIN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$54.97 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.97
|
| Rate for Payer: Blue Shield of California Commercial |
$46.60
|
| Rate for Payer: Blue Shield of California Commercial |
$46.60
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN URINE 24 HOURS
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$54.97 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.97
|
| Rate for Payer: Blue Shield of California Commercial |
$46.60
|
| Rate for Payer: Blue Shield of California Commercial |
$46.60
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROALBUMIN URINE 24 HOURS
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC MICROALBUMIN URINE RANDOM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC MICROALBUMIN URINE RANDOM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
900912210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$54.97 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.97
|
| Rate for Payer: Blue Shield of California Commercial |
$46.60
|
| Rate for Payer: Blue Shield of California Commercial |
$46.60
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC MICROCATH DIREXION
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909000004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.14 |
| Max. Negotiated Rate |
$2,597.60 |
| Rate for Payer: Adventist Health Commercial |
$611.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,888.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,292.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,528.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,864.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.33
|
| 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 Medicare Advantage |
$2,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,803.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,891.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,891.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,457.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,139.20
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,528.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,597.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,597.60
|
|
|
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 |
$1,968.06
|
| 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 Foundation Hospitals Medi-Cal |
$553.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.00
|
|
|
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 Non-Gatekeeper |
$723.06
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$585.23
|
| 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 |
$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 Medicare Advantage |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$558.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$753.48
|
| 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 Foundation Hospitals 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
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909021887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,499.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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 |
$13,770.00 |
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,398.46
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,499.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$1,796.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,398.46
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,940.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,294.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$1,603.35
|
| 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 |
$1,649.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,649.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,781.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,781.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,201.93
|
| 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 |
$13,770.00
|
| 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 |
$1,603.35
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,781.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,781.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
|
