|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$481.10 |
| Max. Negotiated Rate |
$1,993.50 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,711.75
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,799.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,799.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$481.10 |
| Max. Negotiated Rate |
$2,259.30 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,642.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,329.53
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,727.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,645.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,645.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,267.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,329.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.11 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.26
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.95
|
| Rate for Payer: Heritage Provider Network Senior |
$280.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.11 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$256.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.58
|
| Rate for Payer: Blue Shield of California Commercial |
$116.02
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.88
|
| Rate for Payer: Heritage Provider Network Senior |
$256.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$197.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$207.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC BRISK PROFILE
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.29
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$275.45
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$275.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$212.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRISK PROFILE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.58
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.26
|
| Rate for Payer: Heritage Provider Network Senior |
$301.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
IP
|
$2,245.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.35 |
| Max. Negotiated Rate |
$1,683.75 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,445.78
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,519.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,519.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.25
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
OP
|
$2,245.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,387.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,908.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,683.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,459.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,908.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,908.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,908.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,070.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,571.50
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,908.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,908.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,908.25
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
IP
|
$6,261.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,133.24 |
| Max. Negotiated Rate |
$4,695.75 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,032.08
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,238.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,238.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,133.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,565.25
|
| Rate for Payer: Multiplan Commercial |
$4,695.75
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
OP
|
$6,261.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,869.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,321.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,443.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,695.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,069.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,321.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,321.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,321.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,875.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,875.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,986.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,133.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,565.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,382.70
|
| Rate for Payer: Multiplan Commercial |
$4,695.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,321.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,321.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,321.85
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
OP
|
$7,200.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,303.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,440.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,449.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,680.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,456.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,111.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,303.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
IP
|
$7,200.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,303.20 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,440.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,636.80
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,874.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4,874.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,303.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,800.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
IP
|
$6,261.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,133.24 |
| Max. Negotiated Rate |
$4,695.75 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,032.08
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,238.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,238.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,133.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,565.25
|
| Rate for Payer: Multiplan Commercial |
$4,695.75
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
OP
|
$6,261.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,133.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,252.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,869.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cash Price |
$2,817.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,069.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,875.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,111.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,133.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,565.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$4,695.75
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$4,072.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,516.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,483.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,987.14
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,520.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,520.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,942.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,036.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,036.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,622.37
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
OP
|
$13,419.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,428.84 |
| Max. Negotiated Rate |
$17,246.43 |
| Rate for Payer: Adventist Health Commercial |
$2,683.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,292.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,722.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,306.36
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,428.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,354.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$10,064.25
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
IP
|
$13,419.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,428.84 |
| Max. Negotiated Rate |
$10,064.25 |
| Rate for Payer: Adventist Health Commercial |
$2,683.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,641.84
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,084.66
|
| Rate for Payer: Heritage Provider Network Senior |
$9,084.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,428.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,354.75
|
| Rate for Payer: Multiplan Commercial |
$10,064.25
|
|
|
HC BRONCHIAL THERMOPLASTY 2+ LOBES
|
Facility
|
OP
|
$13,419.00
|
|
|
Service Code
|
CPT 31661
|
| Hospital Charge Code |
900831661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,428.84 |
| Max. Negotiated Rate |
$17,246.43 |
| Rate for Payer: Adventist Health Commercial |
$2,683.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,292.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,722.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,306.36
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,428.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,354.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$10,064.25
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC BRONCHIAL THERMOPLASTY 2+ LOBES
|
Facility
|
IP
|
$13,419.00
|
|
|
Service Code
|
CPT 31661
|
| Hospital Charge Code |
900831661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,428.84 |
| Max. Negotiated Rate |
$10,064.25 |
| Rate for Payer: Adventist Health Commercial |
$2,683.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,641.84
|
| Rate for Payer: Cash Price |
$6,038.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,084.66
|
| Rate for Payer: Heritage Provider Network Senior |
$9,084.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,428.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,354.75
|
| Rate for Payer: Multiplan Commercial |
$10,064.25
|
|
|
HC BRONCHOSCOPY W BRONCH ALVEOLAR
|
Facility
|
OP
|
$4,072.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
900803502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,516.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,520.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,349.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC BRONCHOSCOPY W BRONCH ALVEOLAR
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
900803502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,622.37
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC BRONCHOSCOPY W/RMVL OF F.B.
|
Facility
|
OP
|
$4,072.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900501509
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,516.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,934.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,539.22
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,942.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,443.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,443.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC BRONCHOSCOPY W/RMVL OF F.B.
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900501509
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,622.37
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC BRONCH-RADIOELEMENT PLACEMENT
|
Facility
|
OP
|
$5,488.00
|
|
|
Service Code
|
CPT 31643
|
| Hospital Charge Code |
900803506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$993.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,097.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,391.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,347.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,678.14
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,567.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,397.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,397.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,617.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$993.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,744.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,744.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
