|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$4,717.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,240.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,066.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,919.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$3,537.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$4,717.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$853.78 |
| Max. Negotiated Rate |
$3,537.75 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,193.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,193.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| Rate for Payer: Multiplan Commercial |
$3,537.75
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$4,717.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,240.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,066.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,193.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,193.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,250.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$3,537.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,697.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,561.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,306.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,046.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,426.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,616.70
|
| Rate for Payer: Dignity Health Senior |
$1,616.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,177.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$907.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,331.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,331.40
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$951.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,616.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,616.70
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,709.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$541.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,861.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,302.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,489.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,031.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,760.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,302.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,302.65
|
| Rate for Payer: Dignity Health Senior |
$2,302.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,676.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,676.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,292.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,896.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,896.30
|
| Rate for Payer: Multiplan Commercial |
$2,031.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,354.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,354.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,302.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,302.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,302.65
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,709.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,031.75 |
| Rate for Payer: Adventist Health Commercial |
$541.80
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,833.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,833.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.25
|
| Rate for Payer: Multiplan Commercial |
$2,031.75
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,287.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$8,209.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
906820208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.83 |
| Max. Negotiated Rate |
$6,156.75 |
| Rate for Payer: Adventist Health Commercial |
$1,641.80
|
| Rate for Payer: Cash Price |
$3,694.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,557.49
|
| Rate for Payer: Heritage Provider Network Senior |
$5,557.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,052.25
|
| Rate for Payer: Multiplan Commercial |
$6,156.75
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$8,209.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
906820208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,641.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,639.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,694.05
|
| Rate for Payer: Cash Price |
$3,694.05
|
| Rate for Payer: Cash Price |
$3,694.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,335.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,081.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$552.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,052.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,156.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$8,169.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.59 |
| Max. Negotiated Rate |
$6,126.75 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,530.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$8,169.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,612.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,309.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,056.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$552.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,724.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,922.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,879.45
|
| Rate for Payer: Cash Price |
$3,879.45
|
| Rate for Payer: Cash Price |
$3,879.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,603.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,336.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,560.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,465.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$8,169.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,612.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,309.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,056.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,560.40 |
| Max. Negotiated Rate |
$6,465.75 |
| Rate for Payer: Adventist Health Commercial |
$1,724.20
|
| Rate for Payer: Cash Price |
$3,879.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,836.42
|
| Rate for Payer: Heritage Provider Network Senior |
$5,836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,560.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.25
|
| Rate for Payer: Multiplan Commercial |
$6,465.75
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$8,169.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.59 |
| Max. Negotiated Rate |
$6,126.75 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,530.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$515.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,769.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,673.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,593.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$466.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,931.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.07 |
| Max. Negotiated Rate |
$1,931.25 |
| Rate for Payer: Adventist Health Commercial |
$515.00
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,743.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,743.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$466.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.75
|
| Rate for Payer: Multiplan Commercial |
$1,931.25
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.65 |
| Max. Negotiated Rate |
$2,737.50 |
| Rate for Payer: Adventist Health Commercial |
$730.00
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,471.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,471.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.50
|
| Rate for Payer: Multiplan Commercial |
$2,737.50
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,507.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,372.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,259.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$2,737.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
OP
|
$1,754.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Adventist Health Commercial |
$350.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$937.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.11
|
| Rate for Payer: Blue Shield of California Commercial |
$262.61
|
| Rate for Payer: Blue Shield of California EPN |
$211.18
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,085.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,085.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$836.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$1,315.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$696.67
|
| Rate for Payer: TriValley Medical Group Senior |
$696.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
IP
|
$1,754.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.47 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Adventist Health Commercial |
$350.80
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,187.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,187.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.50
|
| Rate for Payer: Multiplan Commercial |
$1,315.50
|
|
|
HC RENAL DILATOR SET
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$287.03
|
| Rate for Payer: Blue Shield of California EPN |
$287.03
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.58
|
| Rate for Payer: Heritage Provider Network Senior |
$330.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.41
|
|
|
HC RENAL DILATOR SET
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$287.03
|
| Rate for Payer: Blue Shield of California EPN |
$287.03
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.90
|
| Rate for Payer: Dignity Health Senior |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.58
|
| Rate for Payer: Heritage Provider Network Senior |
$330.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$499.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$499.80
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$420.75 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$299.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.23
|
| Rate for Payer: Blue Shield of California Commercial |
$69.87
|
| Rate for Payer: Blue Shield of California EPN |
$56.04
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Senior |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.26
|
| Rate for Payer: Heritage Provider Network Senior |
$347.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.94
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$420.75 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.80
|
| Rate for Payer: Heritage Provider Network Senior |
$379.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
|
