|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,777.99
|
| 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 |
$1,366.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,087.51
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,870.05
|
| 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 |
$1,947.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,947.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,372.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,726.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,726.20
|
| 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 DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
OP
|
$3,330.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,057.94
|
| 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 |
$2,031.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,625.04
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,164.50
|
| 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 |
$2,061.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,061.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,588.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$832.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$2,497.50
|
| 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 |
$1,665.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,665.00
|
| 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 DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
IP
|
$3,330.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.73 |
| Max. Negotiated Rate |
$2,497.50 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,144.52
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,254.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,254.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$832.50
|
| Rate for Payer: Multiplan Commercial |
$2,497.50
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| 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 |
$1,857.00
|
| 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 |
$543.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| 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 DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$6,255.00
|
|
|
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 |
$1,251.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,865.59
|
| 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 |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.75
|
| 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 |
$3,871.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,871.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,983.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,132.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| 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 DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,132.15 |
| Max. Negotiated Rate |
$4,691.25 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,028.22
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,234.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,234.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,132.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,132.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,865.59
|
| 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 |
$2,971.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,364.39
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.75
|
| 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 |
$4,234.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,234.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,983.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,132.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,753.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,753.00
|
| 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 DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,132.15 |
| Max. Negotiated Rate |
$4,691.25 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,028.22
|
| Rate for Payer: Cash Price |
$2,814.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,234.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,234.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,132.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,844.55
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,729.71
|
| 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 |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| 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 |
$2,734.12
|
| 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 |
$799.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| 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 DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,729.71
|
| 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 |
$2,098.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,669.63
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| 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 |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,650.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,650.20
|
| 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 DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,844.55
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,844.55
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,729.71
|
| 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 |
$2,694.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,155.50
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| 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 |
$2,734.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,734.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| 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 |
$2,208.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,208.50
|
| 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 DIALYSIS ACCESS DOPPLER
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
906601660
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$253.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$634.25
|
| Rate for Payer: Blue Shield of California Commercial |
$705.89
|
| Rate for Payer: Blue Shield of California EPN |
$567.65
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$824.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$784.89
|
| Rate for Payer: Heritage Provider Network Senior |
$784.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$604.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$951.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC DIALYSIS ACCESS DOPPLER
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
906601660
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$229.51 |
| Max. Negotiated Rate |
$951.00 |
| Rate for Payer: Adventist Health Commercial |
$253.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$816.59
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$858.44
|
| Rate for Payer: Heritage Provider Network Senior |
$858.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Multiplan Commercial |
$951.00
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
OP
|
$6,172.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,814.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,246.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,394.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,629.00
|
| 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 |
$2,777.40
|
| Rate for Payer: Cash Price |
$2,777.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,011.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,246.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,246.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,246.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,820.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,820.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,944.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,117.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,320.40
|
| Rate for Payer: Multiplan Commercial |
$4,629.00
|
| 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 |
$5,246.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,246.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,246.20
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
IP
|
$6,172.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,117.13 |
| Max. Negotiated Rate |
$4,629.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,974.77
|
| Rate for Payer: Cash Price |
$2,777.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,178.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4,178.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,117.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.00
|
| Rate for Payer: Multiplan Commercial |
$4,629.00
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$227.88 |
| Max. Negotiated Rate |
$944.25 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$778.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.75
|
| Rate for Payer: Blue Shield of California Commercial |
$767.99
|
| Rate for Payer: Blue Shield of California EPN |
$614.39
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$818.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$805.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$536.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$779.32
|
| Rate for Payer: Heritage Provider Network Senior |
$779.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$600.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$590.34
|
| Rate for Payer: TriValley Medical Group Senior |
$536.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$629.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$629.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$227.88 |
| Max. Negotiated Rate |
$944.25 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$810.80
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$852.34
|
| Rate for Payer: Heritage Provider Network Senior |
$852.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.75
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.58
|
| Rate for Payer: Blue Shield of California Commercial |
$242.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.74
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.74
|
| Rate for Payer: Heritage Provider Network Senior |
$245.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$189.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.50
|
| Rate for Payer: TriValley Medical Group Senior |
$198.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$198.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$198.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$255.67
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.77
|
| Rate for Payer: Heritage Provider Network Senior |
$268.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
OP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$514.17 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,789.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,275.31
|
| Rate for Payer: Blue Shield of California Commercial |
$962.35
|
| Rate for Payer: Blue Shield of California EPN |
$773.89
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,882.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,882.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,792.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,792.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,381.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$524.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,448.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,448.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
IP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$524.18 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,865.02
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,960.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,960.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$524.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.00
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
|
