|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
IP
|
$4,240.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$767.44 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Adventist Health Commercial |
$848.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,912.88
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,870.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,870.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,060.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.00
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$4,240.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$848.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,912.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care 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 |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,756.00
|
| 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 |
$2,624.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.58
|
| Rate for Payer: Inland Empire Health Plan (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 |
$767.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,060.00
|
| 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 |
$3,180.00
|
| 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 BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
IP
|
$1,573.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.71 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Adventist Health Commercial |
$314.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.65
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.25
|
| Rate for Payer: Multiplan Commercial |
$1,179.75
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
OP
|
$1,573.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$314.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care 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 |
$976.83
|
| Rate for Payer: Blue Shield of California EPN |
$923.35
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,022.45
|
| 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 |
$973.69
|
| Rate for Payer: Heritage Provider Network Senior |
$973.69
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$742.83
|
| Rate for Payer: Inland Empire Health Plan (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 |
$284.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.25
|
| 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 |
$1,179.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$879.07
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| 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 BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$394.40 |
| Max. Negotiated Rate |
$1,634.25 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,496.97
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,475.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,475.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.75
|
| Rate for Payer: Multiplan Commercial |
$1,634.25
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$336.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,496.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care 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 |
$1,353.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,279.07
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,416.35
|
| 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 |
$1,348.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,348.80
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.85
|
| Rate for Payer: Inland Empire Health Plan (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 |
$394.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.75
|
| 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 |
$1,634.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,025.69
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| 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 BREAST TOMO
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$407.25 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,039.25
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,767.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: Dignity Health Senior |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,767.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,683.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,683.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,310.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$492.14 |
| Max. Negotiated Rate |
$2,039.25 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,840.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,840.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$407.25 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,039.25
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,767.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: Dignity Health Senior |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,767.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,683.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,683.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,310.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$492.14 |
| Max. Negotiated Rate |
$2,039.25 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,840.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,840.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
|
|
HC BRISK PROFILE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$167.76 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.77
|
| Rate for Payer: Blue Shield of California Commercial |
$167.76
|
| Rate for Payer: Blue Shield of California EPN |
$131.14
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Humana Medicare |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$24.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRISK PROFILE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.52
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.84
|
| Rate for Payer: Heritage Provider Network Senior |
$316.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.99 |
| Max. Negotiated Rate |
$1,429.50 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,309.42
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,290.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,290.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.50
|
| Rate for Payer: Multiplan Commercial |
$1,429.50
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,309.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,429.50
|
| 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 |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,238.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.10
|
| Rate for Payer: Dignity Health Senior |
$1,620.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,179.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,179.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,686.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$918.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.50
|
| Rate for Payer: Multiplan Commercial |
$1,429.50
|
| 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 |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,371.98 |
| Max. Negotiated Rate |
$5,685.00 |
| Rate for Payer: Adventist Health Commercial |
$1,516.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,207.46
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,131.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5,131.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,516.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,207.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,443.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,169.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,685.00
|
| 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 |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,927.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,443.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,443.00
|
| Rate for Payer: Dignity Health Senior |
$6,443.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,692.02
|
| Rate for Payer: Heritage Provider Network Senior |
$4,692.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,653.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| 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 |
$6,443.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,443.00
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,528.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,284.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,079.83
|
| Rate for Payer: Heritage Provider Network Senior |
$5,755.08
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,289.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$4,943.25 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,528.02
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,371.98 |
| Max. Negotiated Rate |
$5,685.00 |
| Rate for Payer: Adventist Health Commercial |
$1,516.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,207.46
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,131.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5,131.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,370.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,516.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,207.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,927.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,692.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5,755.08
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,370.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$3,727.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$745.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,560.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,314.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,187.75
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,422.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,307.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,307.01
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$2,795.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$3,727.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.59 |
| Max. Negotiated Rate |
$2,795.25 |
| Rate for Payer: Adventist Health Commercial |
$745.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,560.45
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,523.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,523.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.75
|
| Rate for Payer: Multiplan Commercial |
$2,795.25
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
IP
|
$11,669.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,112.09 |
| Max. Negotiated Rate |
$8,751.75 |
| Rate for Payer: Adventist Health Commercial |
$2,333.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,016.60
|
| Rate for Payer: Cash Price |
$5,251.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,899.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7,899.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.25
|
| Rate for Payer: Multiplan Commercial |
$8,751.75
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
OP
|
$11,669.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.97 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$2,333.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,016.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$5,251.05
|
| Rate for Payer: Cash Price |
$5,251.05
|
| Rate for Payer: Cash Price |
$5,251.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,584.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: Dignity Health Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,223.11
|
| Rate for Payer: Heritage Provider Network Senior |
$10,518.34
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,247.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,774.89
|
| Rate for Payer: Multiplan Commercial |
$8,751.75
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| 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 |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC BRONCHIAL THERMOPLASTY 2+ LOBES
|
Facility
|
IP
|
$11,669.00
|
|
|
Service Code
|
CPT 31661
|
| Hospital Charge Code |
900831661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,112.09 |
| Max. Negotiated Rate |
$8,751.75 |
| Rate for Payer: Adventist Health Commercial |
$2,333.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,016.60
|
| Rate for Payer: Cash Price |
$5,251.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,899.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7,899.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.25
|
| Rate for Payer: Multiplan Commercial |
$8,751.75
|
|
