|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
OP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
906820196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.43 |
| Max. Negotiated Rate |
$4,869.75 |
| Rate for Payer: Adventist Health Commercial |
$1,298.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,460.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,220.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,220.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,019.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4,019.17
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$170.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,175.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
IP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
906820196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,175.23 |
| Max. Negotiated Rate |
$4,869.75 |
| Rate for Payer: Adventist Health Commercial |
$1,298.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,460.69
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,395.76
|
| Rate for Payer: Heritage Provider Network Senior |
$4,395.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,175.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.25
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
OP
|
$4,729.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.43 |
| Max. Negotiated Rate |
$3,801.92 |
| Rate for Payer: Adventist Health Commercial |
$945.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,248.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$2,128.05
|
| Rate for Payer: Cash Price |
$2,128.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,073.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,073.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,927.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,927.25
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$170.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$855.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,546.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
OP
|
$3,851.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.51 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$770.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,645.64
|
| 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 |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,732.95
|
| Rate for Payer: Cash Price |
$1,732.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,503.15
|
| 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 |
$2,503.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,383.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,383.77
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$208.51
|
| 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 |
$697.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.75
|
| 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 |
$2,888.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| 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 VENOGRAM SUP SAG SINUS
|
Facility
IP
|
$3,851.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$697.03 |
| Max. Negotiated Rate |
$2,888.25 |
| Rate for Payer: Adventist Health Commercial |
$770.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,645.64
|
| Rate for Payer: Cash Price |
$1,732.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,607.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,607.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.75
|
| Rate for Payer: Multiplan Commercial |
$2,888.25
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
IP
|
$2,937.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,202.75 |
| Rate for Payer: Adventist Health Commercial |
$587.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,017.72
|
| Rate for Payer: Cash Price |
$1,321.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,988.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,988.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.25
|
| Rate for Payer: Multiplan Commercial |
$2,202.75
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
OP
|
$2,937.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$587.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,017.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,496.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,615.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,202.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,321.65
|
| Rate for Payer: Cash Price |
$1,321.65
|
| Rate for Payer: Cash Price |
$1,321.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,909.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.45
|
| Rate for Payer: Dignity Health Senior |
$2,496.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,818.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,818.00
|
| Rate for Payer: IEHP Medi-Cal |
$126.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,415.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.25
|
| Rate for Payer: Multiplan Commercial |
$2,202.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.45
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
IP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
906820169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.17 |
| Max. Negotiated Rate |
$680.25 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$623.11
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$614.04
|
| Rate for Payer: Heritage Provider Network Senior |
$614.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.75
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
OP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
906820169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$623.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$680.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$589.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.95
|
| Rate for Payer: Dignity Health Senior |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.43
|
| Rate for Payer: Heritage Provider Network Senior |
$561.43
|
| Rate for Payer: IEHP Medi-Cal |
$126.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$437.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.75
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
OP
|
$1,943.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,068.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,457.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$874.35
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,262.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: Dignity Health Senior |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.72
|
| Rate for Payer: IEHP Medi-Cal |
$177.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$936.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.75
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
IP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
906820170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$419.25 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.03
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.44
|
| Rate for Payer: Heritage Provider Network Senior |
$378.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
OP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
906820170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$419.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$363.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$475.15
|
| Rate for Payer: Dignity Health Senior |
$475.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.02
|
| Rate for Payer: Heritage Provider Network Senior |
$346.02
|
| Rate for Payer: IEHP Medi-Cal |
$177.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$269.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.15
|
| Rate for Payer: Vantage Medical Group Senior |
$475.15
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
IP
|
$1,943.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$1,457.25 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.84
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,315.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,315.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.75
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
|
|
HC VENOUS ACCESS PORT
|
Facility
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,218.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$957.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,200.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,200.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$886.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$646.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$592.36
|
|
|
HC VENOUS ACCESS PORT
|
Facility
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,218.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,329.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,040.75
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,507.05
|
| Rate for Payer: Dignity Health Senior |
$1,507.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.90
|
| Rate for Payer: Heritage Provider Network Senior |
$820.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$886.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$646.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$592.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
IP
|
$737.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.95
|
| Rate for Payer: Heritage Provider Network Senior |
$498.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
OP
|
$737.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Senior |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.20
|
| Rate for Payer: Heritage Provider Network Senior |
$456.20
|
| Rate for Payer: IEHP Medi-Cal |
$177.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
IP
|
$13,416.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,428.30 |
| Max. Negotiated Rate |
$10,062.00 |
| Rate for Payer: Adventist Health Commercial |
$2,683.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,216.79
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,082.63
|
| Rate for Payer: Heritage Provider Network Senior |
$9,082.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,354.00
|
| Rate for Payer: Multiplan Commercial |
$10,062.00
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
OP
|
$21,515.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,894.22 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$4,303.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,780.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,984.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,317.78
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$4,002.21
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,378.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$16,136.25
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| 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 |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
OP
|
$13,416.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,428.30 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$2,683.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,216.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Cash Price |
$6,037.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,720.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,304.50
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$4,002.21
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,354.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$10,062.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| 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 |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
IP
|
$21,515.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,894.22 |
| Max. Negotiated Rate |
$16,136.25 |
| Rate for Payer: Adventist Health Commercial |
$4,303.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,780.80
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,565.66
|
| Rate for Payer: Heritage Provider Network Senior |
$14,565.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,378.75
|
| Rate for Payer: Multiplan Commercial |
$16,136.25
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
IP
|
$14,344.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,596.26 |
| Max. Negotiated Rate |
$10,758.00 |
| Rate for Payer: Adventist Health Commercial |
$2,868.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,854.33
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,710.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,710.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,596.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,586.00
|
| Rate for Payer: Multiplan Commercial |
$10,758.00
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
OP
|
$14,344.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$693.47 |
| Max. Negotiated Rate |
$11,995.00 |
| Rate for Payer: Adventist Health Commercial |
$2,868.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,854.33
|
| 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 |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,323.60
|
| 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 |
$8,878.94
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$693.47
|
| 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 |
$2,596.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,586.00
|
| 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 |
$10,758.00
|
| 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 VENOUS SAMPLING
|
Facility
OP
|
$11,254.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.62 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,250.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,731.50
|
| 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 |
$3,000.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,064.30
|
| Rate for Payer: Cash Price |
$5,064.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,315.10
|
| 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 |
$7,315.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,966.23
|
| Rate for Payer: Heritage Provider Network Senior |
$6,966.23
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| 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 |
$2,036.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,813.50
|
| 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 |
$8,440.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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 VENOUS SAMPLING
|
Facility
IP
|
$11,254.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,036.97 |
| Max. Negotiated Rate |
$8,440.50 |
| Rate for Payer: Adventist Health Commercial |
$2,250.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,731.50
|
| Rate for Payer: Cash Price |
$5,064.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,618.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7,618.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,036.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,813.50
|
| Rate for Payer: Multiplan Commercial |
$8,440.50
|
|
