|
HC DFIB BS DYNAGEN CRT G151
|
Facility
IP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$22,657.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14,500.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,754.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,313.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,452.17
|
| Rate for Payer: Heritage Provider Network Senior |
$20,452.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,105.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,552.50
|
| Rate for Payer: Multiplan Commercial |
$22,657.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,014.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,093.16
|
|
|
HC DFIB BS DYNAGEN DR D153
|
Facility
OP
|
$25,073.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.60 |
| Max. Negotiated Rate |
$21,312.05 |
| Rate for Payer: Adventist Health Commercial |
$5,014.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,035.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,225.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,312.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,790.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,804.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,570.33
|
| Rate for Payer: Blue Shield of California EPN |
$14,717.85
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,533.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,312.05
|
| Rate for Payer: Dignity Health Senior |
$21,312.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,046.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$11,608.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,536.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,268.25
|
| Rate for Payer: Multiplan Commercial |
$18,804.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,141.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,376.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,312.05
|
| Rate for Payer: Vantage Medical Group Senior |
$21,312.05
|
|
|
HC DFIB BS DYNAGEN DR D153
|
Facility
IP
|
$25,073.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.60 |
| Max. Negotiated Rate |
$18,804.75 |
| Rate for Payer: Adventist Health Commercial |
$5,014.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,035.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,225.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,539.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,974.42
|
| Rate for Payer: Heritage Provider Network Senior |
$16,974.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,536.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,268.25
|
| Rate for Payer: Multiplan Commercial |
$18,804.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,141.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,376.89
|
|
|
HC DFIB MED EVERA MRI DDMB1D4
|
Facility
OP
|
$25,270.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,054.00 |
| Max. Negotiated Rate |
$21,479.50 |
| Rate for Payer: Adventist Health Commercial |
$5,054.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,129.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,360.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,479.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,898.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,952.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,692.67
|
| Rate for Payer: Blue Shield of California EPN |
$14,833.49
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,624.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,479.50
|
| Rate for Payer: Dignity Health Senior |
$21,479.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,172.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,700.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,700.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,635.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,317.50
|
| Rate for Payer: Multiplan Commercial |
$18,952.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,213.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,442.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,479.50
|
| Rate for Payer: Vantage Medical Group Senior |
$21,479.50
|
|
|
HC DFIB MED EVERA MRI DDMB1D4
|
Facility
IP
|
$25,270.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,054.00 |
| Max. Negotiated Rate |
$18,952.50 |
| Rate for Payer: Adventist Health Commercial |
$5,054.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,129.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,360.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,624.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,645.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,107.79
|
| Rate for Payer: Heritage Provider Network Senior |
$17,107.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,635.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,317.50
|
| Rate for Payer: Multiplan Commercial |
$18,952.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,213.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,442.71
|
|
|
HC DFIB MED EVERA MRI DDMC3D4
|
Facility
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,115.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,352.50
|
|
|
HC DFIB MED EVERA MRI DDMC3D4
|
Facility
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,525.00
|
| Rate for Payer: Blue Shield of California EPN |
$14,675.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Senior |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,115.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB MED EVERA MRI DVMB1D4
|
Facility
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,115.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,352.50
|
|
|
HC DFIB MED EVERA MRI DVMB1D4
|
Facility
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,525.00
|
| Rate for Payer: Blue Shield of California EPN |
$14,675.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Senior |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,115.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB STJ QUIAD ASSUR CD3365-40Q
|
Facility
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$18,810.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,038.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,229.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,543.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,979.16
|
| Rate for Payer: Heritage Provider Network Senior |
$16,979.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,540.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,144.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,379.23
|
|
|
HC DFIB STJ QUIAD ASSUR CD3365-40Q
|
Facility
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,038.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,229.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,574.68
|
| Rate for Payer: Blue Shield of California EPN |
$14,721.96
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,536.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Senior |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,051.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,612.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11,612.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,540.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,144.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,379.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ UNIFY ASSURA CD3357-40C
|
Facility
IP
|
$23,655.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.00 |
| Max. Negotiated Rate |
$17,741.25 |
| Rate for Payer: Adventist Health Commercial |
$4,731.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,354.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,250.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,773.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,014.44
|
| Rate for Payer: Heritage Provider Network Senior |
$16,014.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,827.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,913.75
|
| Rate for Payer: Multiplan Commercial |
$17,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,624.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,903.14
|
|
|
HC DFIB STJ UNIFY ASSURA CD3357-40C
|
Facility
OP
|
$23,655.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.00 |
| Max. Negotiated Rate |
$20,106.75 |
| Rate for Payer: Adventist Health Commercial |
$4,731.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,354.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,250.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,106.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,010.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17,741.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,689.76
|
| Rate for Payer: Blue Shield of California EPN |
$13,885.48
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,881.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,106.75
|
| Rate for Payer: Dignity Health Senior |
$20,106.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,139.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,952.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,952.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,827.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,913.75
|
| Rate for Payer: Multiplan Commercial |
$17,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,624.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,903.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,106.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,106.75
|
|
|
HC DHEA-S
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$186.07 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.07
|
| Rate for Payer: Blue Shield of California Commercial |
$173.68
|
| Rate for Payer: Blue Shield of California EPN |
$135.78
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Senior |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Humana Medicare |
$22.23
|
| Rate for Payer: IEHP Medi-Cal |
$30.61
|
| Rate for Payer: IEHP Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.01
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.23
|
| Rate for Payer: TriValley Medical Group Senior |
$22.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DHEA-S
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.92
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.86
|
| Rate for Payer: Heritage Provider Network Senior |
$274.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.64
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$77.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.12
|
| Rate for Payer: Heritage Provider Network Senior |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
IP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.75 |
| Max. Negotiated Rate |
$1,975.50 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,783.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,783.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
OP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare 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 |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,712.10
|
| 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 |
$1,630.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,608.36
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$257.29
|
| Rate for Payer: 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 |
$476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| 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 |
$1,975.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| 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 |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
OP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare 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: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,712.10
|
| 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 |
$1,783.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,783.22
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,269.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| 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 |
$1,975.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$956.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$880.02
|
| 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 DIAGNOSTIC BRONCH
|
Facility
IP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.75 |
| Max. Negotiated Rate |
$1,975.50 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,783.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,783.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$609.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,093.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare 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 |
$1,892.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,789.18
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,981.20
|
| 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 |
$1,886.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,886.71
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$314.20
|
| Rate for Payer: 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 |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| 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 |
$2,286.00
|
| 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 DIAGNOSTIC BRONCH W BIOPSY
|
Facility
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$551.69 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Adventist Health Commercial |
$609.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,093.98
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,063.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,063.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$2,286.00
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.03 |
| Max. Negotiated Rate |
$2,059.50 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,784.90
|
| 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 |
$1,699.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,608.36
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$329.89
|
| Rate for Payer: 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 |
$497.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| 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 |
$2,059.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| 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 |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
