|
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 |
$2,998.46
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$2,877.41
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$2,328.93
|
| 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 |
$2,095.20
|
| 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 Medicare Advantage |
$3,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,882.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,882.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,220.91
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
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 |
$2,335.79
|
| 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 Foundation Hospitals 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 |
$656.49 |
| Max. Negotiated Rate |
$3,082.95 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,241.49
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,814.23
|
| 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 |
$1,632.15
|
| 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 Medicare Advantage |
$3,082.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,139.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,245.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,245.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 Non-Gatekeeper |
$1,829.28
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,480.59
|
| 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 |
$1,332.00
|
| 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 Medicare Advantage |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,746.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,832.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,832.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,411.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$740.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$1,906.24
|
| 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 Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,012.75
|
| 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 |
$13,770.00
|
| 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 |
$2,193.75
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,139.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$2,193.75
|
| 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 |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909011887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,139.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$2,193.75
|
| 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 |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,012.75
|
| 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 |
$13,770.00
|
| 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 |
$2,193.75
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$1,821.23
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$1,747.70
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,414.57
|
| 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 |
$1,272.60
|
| 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 Medicare Advantage |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,750.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,750.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,348.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$511.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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: Aetna of CA Non-Gatekeeper |
$122.36
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Foundation Hospitals 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/CRYSTALS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
900910153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$67.82 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.99
|
| 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 Medi-Cal |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.82
|
| Rate for Payer: Blue Shield of California Commercial |
$57.54
|
| Rate for Payer: Blue Shield of California Commercial |
$57.54
|
| Rate for Payer: Blue Shield of California EPN |
$46.15
|
| Rate for Payer: Blue Shield of California EPN |
$46.15
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$123.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$117.61
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$90.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$10.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.06
|
| Rate for Payer: Vantage Medical Group Senior |
$7.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7.33
|
|
|
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: Aetna of CA Non-Gatekeeper |
$103.68
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/SPERM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$114.36 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| 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 Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.36
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$99.66
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
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: Aetna of CA Non-Gatekeeper |
$100.46
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC MICROFIL LARVA
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MICROFIL LARVA
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC MICROGLOBULIN
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900912121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.63
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC MICROGLOBULIN
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900912121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.67
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California Commercial |
$130.23
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Blue Shield of California EPN |
$104.46
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$89.14
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$68.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$84.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC MICROGUIDEWIRE
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$445.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.12
|
| Rate for Payer: Blue Shield of California Commercial |
$362.34
|
| Rate for Payer: Blue Shield of California EPN |
$289.87
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$504.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.69
|
| Rate for Payer: Heritage Provider Network Senior |
$367.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$283.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$415.80
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$297.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.90
|
| Rate for Payer: Vantage Medical Group Senior |
$504.90
|
|
|
HC MICROGUIDEWIRE
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$382.54
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.14
|
| Rate for Payer: Heritage Provider Network Senior |
$402.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
