|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$2,139.75 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,931.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,931.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.25
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
|
|
HC MYOCARDIAL STRAIN IMAGING
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
900200356
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
|
|
HC MYOCARDIAL STRAIN IMAGING
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
900200356
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$1,670.25 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,050.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,349.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.65
|
| Rate for Payer: Blue Shield of California EPN |
$958.92
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,277.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,670.25
|
| Rate for Payer: Dignity Health Senior |
$1,670.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,216.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,216.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$937.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,375.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,375.50
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$313.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,670.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,670.25
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$141.78 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$693.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$891.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$843.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$802.84
|
| Rate for Payer: Heritage Provider Network Senior |
$802.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$618.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$648.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.07
|
| Rate for Payer: Heritage Provider Network Senior |
$878.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.51
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.81
|
| Rate for Payer: Heritage Provider Network Senior |
$96.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.25
|
| Rate for Payer: Blue Shield of California Commercial |
$103.91
|
| Rate for Payer: Blue Shield of California EPN |
$83.34
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Senior |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.52
|
| Rate for Payer: Heritage Provider Network Senior |
$88.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.28
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.92
|
| Rate for Payer: TriValley Medical Group Senior |
$12.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
OP
|
$1,518.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$303.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,042.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$986.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$986.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,027.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,027.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$724.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$1,138.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$546.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$502.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
|
IP
|
$1,518.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.76 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$303.60
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,027.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,027.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.50
|
| Rate for Payer: Multiplan Commercial |
$1,138.50
|
|
|
HC NA (POC)
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.76
|
| Rate for Payer: Blue Shield of California Commercial |
$38.71
|
| Rate for Payer: Blue Shield of California EPN |
$31.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.33
|
| Rate for Payer: Heritage Provider Network Senior |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC NA (POC)
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$61.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
|
|
HC NASAL BONES
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$496.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$397.65
|
| Rate for Payer: Cash Price |
$397.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$469.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$447.54
|
| Rate for Payer: Heritage Provider Network Senior |
$447.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$344.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC NASAL BONES
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Cash Price |
$397.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.47
|
| Rate for Payer: Heritage Provider Network Senior |
$489.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$345.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Senior |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$246.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$253.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$310.80
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$176.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
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: Cash Price |
$2,429.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Permanente of CA 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 NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,034.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| 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) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,589.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,462.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Adventist Health Commercial |
$372.40
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,260.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,260.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.50
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$372.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,279.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,210.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,260.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,260.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$888.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$669.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$616.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC NASAL/SINUS ENDOSCOPY W/BX
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
950442337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.92 |
| Max. Negotiated Rate |
$3,571.50 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,223.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,223.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.50
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
|
|
HC NASAL/SINUS ENDOSCOPY W/BX
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
950442337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,271.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,619.10
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,095.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,947.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,163.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| 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 |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$623.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| 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 |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
