|
HC BRONCH W BLLN OCC ADD LOBES
|
Facility
IP
|
$5,205.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900831651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$942.10 |
| Max. Negotiated Rate |
$3,903.75 |
| Rate for Payer: Adventist Health Commercial |
$1,041.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,575.84
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,523.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,523.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$942.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,301.25
|
| Rate for Payer: Multiplan Commercial |
$3,903.75
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
OP
|
$5,106.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.05 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$1,021.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,507.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare 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 |
$3,170.83
|
| Rate for Payer: Blue Shield of California EPN |
$2,997.22
|
| Rate for Payer: Cash Price |
$2,297.70
|
| Rate for Payer: Cash Price |
$2,297.70
|
| Rate for Payer: Cash Price |
$2,297.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,318.90
|
| 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 |
$3,160.61
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.61
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: IEHP Medi-Cal |
$271.05
|
| Rate for Payer: 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 |
$924.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.50
|
| 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 |
$3,829.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| 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 BRONCH W/BLLN OCCLUSION
|
Facility
IP
|
$5,106.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.19 |
| Max. Negotiated Rate |
$3,829.50 |
| Rate for Payer: Adventist Health Commercial |
$1,021.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,507.82
|
| Rate for Payer: Cash Price |
$2,297.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,456.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,456.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.50
|
| Rate for Payer: Multiplan Commercial |
$3,829.50
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
IP
|
$13,894.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,514.81 |
| Max. Negotiated Rate |
$10,420.50 |
| Rate for Payer: Adventist Health Commercial |
$2,778.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,545.18
|
| Rate for Payer: Cash Price |
$6,252.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,406.24
|
| Rate for Payer: Heritage Provider Network Senior |
$9,406.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,514.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,473.50
|
| Rate for Payer: Multiplan Commercial |
$10,420.50
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
OP
|
$13,894.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$585.44 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$2,778.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,545.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare 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 |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$6,252.30
|
| Rate for Payer: Cash Price |
$6,252.30
|
| Rate for Payer: Cash Price |
$6,252.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,031.10
|
| 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 |
$8,600.39
|
| Rate for Payer: Heritage Provider Network Senior |
$10,518.34
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: IEHP Medi-Cal |
$585.44
|
| Rate for Payer: 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 |
$2,514.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,473.50
|
| 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 |
$10,420.50
|
| 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 BRONCH W/TUMOR EXCISION
|
Facility
OP
|
$10,697.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,139.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,348.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,642.84
|
| Rate for Payer: Blue Shield of California EPN |
$6,279.14
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,953.05
|
| 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 |
$6,621.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6,621.44
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$328.72
|
| Rate for Payer: 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 |
$1,936.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.25
|
| 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 |
$8,022.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| 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 W/TUMOR EXCISION
|
Facility
IP
|
$10,697.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,936.16 |
| Max. Negotiated Rate |
$8,022.75 |
| Rate for Payer: Adventist Health Commercial |
$2,139.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,348.84
|
| Rate for Payer: Cash Price |
$4,813.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,241.87
|
| Rate for Payer: Heritage Provider Network Senior |
$7,241.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,936.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.25
|
| Rate for Payer: Multiplan Commercial |
$8,022.75
|
|
|
HC BUFFY COAT EXAM
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Adventist Health Commercial |
$55.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$191.67
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.88
|
| Rate for Payer: Heritage Provider Network Senior |
$188.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$209.25
|
|
|
HC BUFFY COAT EXAM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.11
|
| Rate for Payer: Blue Shield of California Commercial |
$29.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Senior |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.07
|
| Rate for Payer: IEHP Medi-Cal |
$6.32
|
| Rate for Payer: IEHP Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.39
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUN
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.02
|
| Rate for Payer: Blue Shield of California Commercial |
$30.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.08
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.95
|
| Rate for Payer: IEHP Medi-Cal |
$4.91
|
| Rate for Payer: IEHP Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC BUN BODY FLUID
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC BUN BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.02
|
| Rate for Payer: Blue Shield of California Commercial |
$30.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.08
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$3.95
|
| Rate for Payer: IEHP Medi-Cal |
$4.91
|
| Rate for Payer: IEHP Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
OP
|
$4,593.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,155.39
|
| 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 |
$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 |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,985.45
|
| 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 |
$2,843.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$259.62
|
| 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 |
$831.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.25
|
| 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 |
$3,444.75
|
| 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 BX BREAST 1ST LESION MR IMAG
|
Facility
IP
|
$4,593.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$831.33 |
| Max. Negotiated Rate |
$3,444.75 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,155.39
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,109.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3,109.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$831.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$3,444.75
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
OP
|
$4,106.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$743.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$821.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,820.82
|
| 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 |
$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 |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,668.90
|
| 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 |
$2,541.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$986.19
|
| 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 |
$743.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.50
|
| 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 |
$3,079.50
|
| 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 BX BREAST 1ST LESION STRTCTC
|
Facility
IP
|
$4,106.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$743.19 |
| Max. Negotiated Rate |
$3,079.50 |
| Rate for Payer: Adventist Health Commercial |
$821.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,820.82
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,779.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,779.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.50
|
| Rate for Payer: Multiplan Commercial |
$3,079.50
|
|
|
HC BX BREAST 1ST LESION US IMAG
|
Facility
IP
|
$4,969.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$899.39 |
| Max. Negotiated Rate |
$3,726.75 |
| Rate for Payer: Adventist Health Commercial |
$993.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,413.70
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,364.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,364.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$899.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,242.25
|
| Rate for Payer: Multiplan Commercial |
$3,726.75
|
|
|
HC BX BREAST 1ST LESION US IMAG
|
Facility
OP
|
$4,969.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$899.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$993.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,413.70
|
| 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 |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,085.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,916.80
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cash Price |
$2,236.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,229.85
|
| 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 |
$3,075.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3,075.81
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$957.72
|
| 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 |
$899.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,242.25
|
| 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 |
$3,726.75
|
| 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 BX BREAST ADD LESION MR IMAG
|
Facility
OP
|
$4,833.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$966.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,320.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,108.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,658.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$2,174.85
|
| Rate for Payer: Cash Price |
$2,174.85
|
| Rate for Payer: Cash Price |
$2,174.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,141.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,108.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,108.05
|
| Rate for Payer: Dignity Health Senior |
$4,108.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,991.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,991.63
|
| Rate for Payer: IEHP Medi-Cal |
$120.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,329.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$874.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,208.25
|
| Rate for Payer: Multiplan Commercial |
$3,624.75
|
| 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 |
$4,108.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,108.05
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
IP
|
$4,833.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.77 |
| Max. Negotiated Rate |
$3,624.75 |
| Rate for Payer: Adventist Health Commercial |
$966.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,320.27
|
| Rate for Payer: Cash Price |
$2,174.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,271.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,271.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$874.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,208.25
|
| Rate for Payer: Multiplan Commercial |
$3,624.75
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
IP
|
$4,028.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$729.07 |
| Max. Negotiated Rate |
$3,021.00 |
| Rate for Payer: Adventist Health Commercial |
$805.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,767.24
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,726.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,726.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.00
|
| Rate for Payer: Multiplan Commercial |
$3,021.00
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
OP
|
$4,028.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$729.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$805.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,767.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,423.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,215.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,021.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,618.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,423.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,423.80
|
| Rate for Payer: Dignity Health Senior |
$3,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,493.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2,493.33
|
| Rate for Payer: IEHP Medi-Cal |
$821.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,941.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.00
|
| Rate for Payer: Multiplan Commercial |
$3,021.00
|
| 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 |
$3,423.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,423.80
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
OP
|
$3,026.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$547.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$605.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,078.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,572.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,269.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,776.26
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,966.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,572.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,572.10
|
| Rate for Payer: Dignity Health Senior |
$2,572.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,873.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,873.09
|
| Rate for Payer: IEHP Medi-Cal |
$790.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,458.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.50
|
| Rate for Payer: Multiplan Commercial |
$2,269.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,572.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,572.10
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
IP
|
$3,026.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$547.71 |
| Max. Negotiated Rate |
$2,269.50 |
| Rate for Payer: Adventist Health Commercial |
$605.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,078.86
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,048.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,048.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.50
|
| Rate for Payer: Multiplan Commercial |
$2,269.50
|
|
