|
HC PROTEIN URINE 24 HOURS
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC PROTEIN URINE 24 HOURS
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: IEHP Medi-Cal |
$5.09
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: IEHP Medi-Cal |
$5.09
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$264.85 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.85
|
| Rate for Payer: Blue Shield of California Commercial |
$104.33
|
| Rate for Payer: Blue Shield of California EPN |
$98.62
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: Dignity Health Senior |
$65.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Humana Medicare |
$65.69
|
| Rate for Payer: IEHP Medicare Advantage |
$65.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.77
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.69
|
| Rate for Payer: TriValley Medical Group Senior |
$65.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
IP
|
$632.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.39 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.18
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.86
|
| Rate for Payer: Heritage Provider Network Senior |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.00
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
|
|
HC PROTHROMBIN G20210A MUTATN B
|
Facility
OP
|
$103.50
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900913620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$264.85 |
| Rate for Payer: Adventist Health Commercial |
$20.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.85
|
| Rate for Payer: Blue Shield of California Commercial |
$64.27
|
| Rate for Payer: Blue Shield of California EPN |
$60.75
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: Dignity Health Senior |
$65.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.07
|
| Rate for Payer: Heritage Provider Network Senior |
$64.07
|
| Rate for Payer: Humana Medicare |
$65.69
|
| Rate for Payer: IEHP Medicare Advantage |
$65.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.77
|
| Rate for Payer: Multiplan Commercial |
$77.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.69
|
| Rate for Payer: TriValley Medical Group Senior |
$65.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
|
|
HC PROTHROMBIN G20210A MUTATN B
|
Facility
IP
|
$103.50
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900913620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$77.62 |
| Rate for Payer: Adventist Health Commercial |
$20.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.10
|
| Rate for Payer: Cash Price |
$46.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.07
|
| Rate for Payer: Heritage Provider Network Senior |
$70.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.88
|
| Rate for Payer: Multiplan Commercial |
$77.62
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$30.69
|
| Rate for Payer: Blue Shield of California EPN |
$23.99
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Senior |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: IEHP Medi-Cal |
$5.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$30.69
|
| Rate for Payer: Blue Shield of California EPN |
$23.99
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Senior |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: IEHP Medi-Cal |
$5.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
IP
|
$1,430.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$258.83 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.41
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$968.11
|
| Rate for Payer: Heritage Provider Network Senior |
$968.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.50
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
OP
|
$1,430.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$563.11
|
| Rate for Payer: Blue Shield of California EPN |
$320.23
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$929.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$885.17
|
| Rate for Payer: Heritage Provider Network Senior |
$885.17
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
OP
|
$707.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$141.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$485.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$318.15
|
| Rate for Payer: Cash Price |
$318.15
|
| Rate for Payer: Cash Price |
$318.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$459.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.63
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$243.94
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$530.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
IP
|
$707.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$530.25 |
| Rate for Payer: Adventist Health Commercial |
$141.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$485.71
|
| Rate for Payer: Cash Price |
$318.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$478.64
|
| Rate for Payer: Heritage Provider Network Senior |
$478.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.75
|
| Rate for Payer: Multiplan Commercial |
$530.25
|
|
|
HC PTA FEM/POP
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,478.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,978.28
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$607.60
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA FEM/POP
|
Facility
IP
|
$14,338.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,595.18 |
| Max. Negotiated Rate |
$10,753.50 |
| Rate for Payer: Adventist Health Commercial |
$2,867.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,850.21
|
| Rate for Payer: Cash Price |
$6,452.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,706.83
|
| Rate for Payer: Heritage Provider Network Senior |
$9,706.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,595.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,584.50
|
| Rate for Payer: Multiplan Commercial |
$10,753.50
|
|
|
HC PTA FEM/POP
|
Facility
OP
|
$14,338.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$2,867.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,850.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,452.10
|
| Rate for Payer: Cash Price |
$6,452.10
|
| Rate for Payer: Cash Price |
$6,452.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,319.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,875.22
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$607.60
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,595.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,584.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$10,753.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA FEM/POP
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,917.72 |
| Max. Negotiated Rate |
$12,090.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,913.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10,913.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
|
|
HC PTA ILIAC
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$551.27 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,478.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,978.28
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$551.27
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA ILIAC
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,917.72 |
| Max. Negotiated Rate |
$12,090.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,913.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10,913.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
|
|
HC PTA ILIAC
|
Facility
OP
|
$21,052.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$551.27 |
| Max. Negotiated Rate |
$15,789.00 |
| Rate for Payer: Adventist Health Commercial |
$4,210.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,462.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,683.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,031.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$551.27
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,263.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$15,789.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTA ILIAC
|
Facility
IP
|
$21,052.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,810.41 |
| Max. Negotiated Rate |
$15,789.00 |
| Rate for Payer: Adventist Health Commercial |
$4,210.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,462.72
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,252.20
|
| Rate for Payer: Heritage Provider Network Senior |
$14,252.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,263.00
|
| Rate for Payer: Multiplan Commercial |
$15,789.00
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
OP
|
$14,033.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.08 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,806.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,640.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,928.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,718.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,524.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,121.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,928.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,928.05
|
| Rate for Payer: Dignity Health Senior |
$11,928.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,686.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,686.43
|
| Rate for Payer: IEHP Medi-Cal |
$250.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,763.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,539.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.25
|
| Rate for Payer: Multiplan Commercial |
$10,524.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,928.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,928.05
|
|
