|
HC RENAL BILAT 2ND ORDER
|
Facility
OP
|
$10,117.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,576.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,262.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$532.26
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
IP
|
$10,117.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,831.18 |
| Max. Negotiated Rate |
$7,587.75 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,849.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,849.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
IP
|
$10,117.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,831.18 |
| Max. Negotiated Rate |
$7,587.75 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,849.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,849.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,815.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,234.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,898.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,617.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$462.60
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
906820207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,642.58 |
| Max. Negotiated Rate |
$6,806.25 |
| Rate for Payer: Adventist Health Commercial |
$1,815.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,234.52
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,143.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,143.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.75
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
OP
|
$10,117.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,576.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,262.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$462.60
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.62 |
| Max. Negotiated Rate |
$1,767.75 |
| Rate for Payer: Adventist Health Commercial |
$471.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.26
|
| Rate for Payer: Cash Price |
$1,060.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,595.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,595.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.25
|
| Rate for Payer: Multiplan Commercial |
$1,767.75
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
OP
|
$2,357.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$471.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$1,060.65
|
| Rate for Payer: Cash Price |
$1,060.65
|
| Rate for Payer: Cash Price |
$1,060.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,532.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$110.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,767.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
OP
|
$3,537.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,429.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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 |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,299.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,189.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$110.35
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
IP
|
$3,537.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$640.20 |
| Max. Negotiated Rate |
$2,652.75 |
| Rate for Payer: Adventist Health Commercial |
$707.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,429.92
|
| Rate for Payer: Cash Price |
$1,591.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,394.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,394.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.25
|
| Rate for Payer: Multiplan Commercial |
$2,652.75
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
IP
|
$1,605.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$1,203.75 |
| Rate for Payer: Adventist Health Commercial |
$321.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,102.64
|
| Rate for Payer: Cash Price |
$722.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$1,203.75
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
OP
|
$1,605.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$1,309.63 |
| Rate for Payer: Adventist Health Commercial |
$321.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$512.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,102.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.90
|
| Rate for Payer: Blue Shield of California Commercial |
$254.95
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$722.25
|
| Rate for Payer: Cash Price |
$722.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,043.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,043.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$993.50
|
| Rate for Payer: Heritage Provider Network Senior |
$993.50
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$67.52
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$1,203.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| 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 |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$535.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$443.39
|
| Rate for Payer: Blue Shield of California EPN |
$419.12
|
| 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: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| 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 |
$483.38
|
| Rate for Payer: Heritage Provider Network Senior |
$483.38
|
| 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 |
$260.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.55
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.64
|
| Rate for Payer: Blue Shield of California Commercial |
$67.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.01
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$390.00
|
| 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 |
$390.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$371.40
|
| Rate for Payer: Heritage Provider Network Senior |
$371.40
|
| Rate for Payer: Humana Medicare |
$8.68
|
| Rate for Payer: IEHP Medi-Cal |
$11.86
|
| Rate for Payer: IEHP Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| 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 |
$450.00
|
| 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
|
$600.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.20
|
| Rate for Payer: Heritage Provider Network Senior |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
IP
|
$10,117.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,831.18 |
| Max. Negotiated Rate |
$7,587.75 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,849.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,849.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
OP
|
$10,117.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.38 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,576.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,262.42
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$493.38
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,564.02 |
| Max. Negotiated Rate |
$6,480.75 |
| Rate for Payer: Adventist Health Commercial |
$1,728.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,936.37
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,849.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5,849.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,160.25
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.38 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$1,728.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,936.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,616.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,348.78
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$493.38
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,642.58 |
| Max. Negotiated Rate |
$6,806.25 |
| Rate for Payer: Adventist Health Commercial |
$1,815.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,234.52
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,143.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,143.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.75
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
OP
|
$10,117.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,576.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,262.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$355.23
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
IP
|
$10,117.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,831.18 |
| Max. Negotiated Rate |
$7,587.75 |
| Rate for Payer: Adventist Health Commercial |
$2,023.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,552.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,849.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,849.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,529.25
|
| Rate for Payer: Multiplan Commercial |
$7,587.75
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,815.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,234.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,898.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,617.42
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$355.23
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$445.08 |
| Max. Negotiated Rate |
$1,844.25 |
| Rate for Payer: Adventist Health Commercial |
$491.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,689.33
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,664.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,664.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.75
|
| Rate for Payer: Multiplan Commercial |
$1,844.25
|
|
