|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
IP
|
$5,725.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,036.22 |
| Max. Negotiated Rate |
$4,293.75 |
| Rate for Payer: Adventist Health Commercial |
$1,145.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,933.08
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,875.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,875.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.25
|
| Rate for Payer: Multiplan Commercial |
$4,293.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
OP
|
$5,725.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,145.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,933.08
|
| 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 |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,721.25
|
| 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 |
$3,875.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,875.82
|
| 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 |
$2,759.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.25
|
| 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 |
$4,293.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,078.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,912.72
|
| 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 LARYNGOSCOPY
|
Facility
IP
|
$5,725.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,036.22 |
| Max. Negotiated Rate |
$4,293.75 |
| Rate for Payer: Adventist Health Commercial |
$1,145.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,933.08
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,875.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,875.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.25
|
| Rate for Payer: Multiplan Commercial |
$4,293.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
OP
|
$5,725.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,145.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,933.08
|
| 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 |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cash Price |
$2,576.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,721.25
|
| 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 |
$3,543.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,543.78
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$263.09
|
| 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 |
$1,036.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.25
|
| 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 |
$4,293.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| 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 LARYNGOSCOPY W/MICR
|
Facility
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| 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 |
$2,510.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,373.24
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,627.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,502.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,502.62
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$215.47
|
| 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 |
$731.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| 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 |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,627.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,502.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,608.36
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$215.47
|
| 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 |
$731.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| 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 LARYNGOSCOPY W/MICR
|
Facility
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| 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 |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,627.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| 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 |
$1,948.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,468.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,350.77
|
| 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 LARYNGOSCOPY W/MICR
|
Facility
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
|
|
HC DIALYSIS ACCESS DOPPLER
|
Facility
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
906601660
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$1,178.25 |
| Rate for Payer: Adventist Health Commercial |
$314.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$231.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,079.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$685.30
|
| Rate for Payer: Blue Shield of California EPN |
$389.71
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,021.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,021.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$972.45
|
| Rate for Payer: Heritage Provider Network Senior |
$972.45
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$111.93
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,178.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DIALYSIS ACCESS DOPPLER
|
Facility
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
906601660
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$284.35 |
| Max. Negotiated Rate |
$1,178.25 |
| Rate for Payer: Adventist Health Commercial |
$314.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,079.28
|
| Rate for Payer: Cash Price |
$706.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,063.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,063.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.75
|
| Rate for Payer: Multiplan Commercial |
$1,178.25
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
IP
|
$7,232.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,308.99 |
| Max. Negotiated Rate |
$5,424.00 |
| Rate for Payer: Adventist Health Commercial |
$1,446.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,968.38
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,896.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4,896.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,308.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,808.00
|
| Rate for Payer: Multiplan Commercial |
$5,424.00
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
OP
|
$7,232.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,446.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,968.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,147.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,977.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,424.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,700.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,147.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,147.20
|
| Rate for Payer: Dignity Health Senior |
$6,147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,476.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,476.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,817.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,485.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,308.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,808.00
|
| Rate for Payer: Multiplan Commercial |
$5,424.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,147.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,147.20
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
IP
|
$363.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
OP
|
$363.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Blue Shield of California Commercial |
$225.42
|
| Rate for Payer: Blue Shield of California EPN |
$213.08
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.70
|
| Rate for Payer: Heritage Provider Network Senior |
$224.70
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: IEHP Medi-Cal |
$59.28
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$181.50
|
| Rate for Payer: TriValley Medical Group Senior |
$181.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
OP
|
$3,586.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$277.04 |
| Max. Negotiated Rate |
$2,689.50 |
| Rate for Payer: Adventist Health Commercial |
$717.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$363.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,463.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.26
|
| Rate for Payer: Blue Shield of California Commercial |
$934.28
|
| Rate for Payer: Blue Shield of California EPN |
$531.30
|
| Rate for Payer: Cash Price |
$1,613.70
|
| Rate for Payer: Cash Price |
$1,613.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,330.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,330.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,219.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,219.73
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$277.04
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$649.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$2,689.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
IP
|
$3,586.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$649.07 |
| Max. Negotiated Rate |
$2,689.50 |
| Rate for Payer: Adventist Health Commercial |
$717.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,463.58
|
| Rate for Payer: Cash Price |
$1,613.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,427.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$649.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.50
|
| Rate for Payer: Multiplan Commercial |
$2,689.50
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$102.63 |
| Max. Negotiated Rate |
$425.25 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$389.53
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.86
|
| Rate for Payer: Heritage Provider Network Senior |
$383.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$102.63 |
| Max. Negotiated Rate |
$600.25 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$223.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$389.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$425.25
|
| Rate for Payer: Blue Shield of California Commercial |
$600.25
|
| Rate for Payer: Blue Shield of California EPN |
$341.35
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$368.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.95
|
| Rate for Payer: Dignity Health Senior |
$481.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.97
|
| Rate for Payer: Heritage Provider Network Senior |
$350.97
|
| Rate for Payer: IEHP Medi-Cal |
$186.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$168.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.95
|
| Rate for Payer: Vantage Medical Group Senior |
$481.95
|
|
|
HC DIGOXIN
|
Facility
IP
|
$196.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC DIGOXIN
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$111.12 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.12
|
| Rate for Payer: Blue Shield of California Commercial |
$103.69
|
| Rate for Payer: Blue Shield of California EPN |
$81.06
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Senior |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$13.28
|
| Rate for Payer: IEHP Medi-Cal |
$18.41
|
| Rate for Payer: IEHP Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.73
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
IP
|
$4,986.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$902.47 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,425.38
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,375.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.50
|
| Rate for Payer: Multiplan Commercial |
$3,739.50
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
OP
|
$7,336.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$235.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,467.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,039.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,301.20
|
| Rate for Payer: Cash Price |
$3,301.20
|
| Rate for Payer: Cash Price |
$3,301.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,768.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,540.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$235.22
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,834.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$5,502.00
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$269.51 |
| Max. Negotiated Rate |
$1,116.75 |
| Rate for Payer: Adventist Health Commercial |
$297.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,022.94
|
| Rate for Payer: Cash Price |
$670.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,008.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,008.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.25
|
| Rate for Payer: Multiplan Commercial |
$1,116.75
|
|
