|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| 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: 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 |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| 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: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$149.66
|
| 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
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| 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/OROGASTRIC TUBE PLACEMENT
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$608.62
|
| Rate for Payer: Heritage Provider Network Senior |
$608.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.75
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$617.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Cash Price |
$494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$584.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$608.62
|
| Rate for Payer: Heritage Provider Network Senior |
$608.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$428.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$323.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NASOPHARYNGOGRAM
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Adventist Health Commercial |
$131.20
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.11
|
| Rate for Payer: Heritage Provider Network Senior |
$444.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
|
|
HC NASOPHARYNGOGRAM
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Adventist Health Commercial |
$131.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$350.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$450.67
|
| 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 |
$340.32
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$426.40
|
| 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 |
$426.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.06
|
| Rate for Payer: Heritage Provider Network Senior |
$406.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$312.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| 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 |
$492.00
|
| 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 |
$141.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.02
|
| 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 NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$424.57
|
| 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 |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.70
|
| 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 |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$246.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| 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 |
$294.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| 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 |
$463.50
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$222.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$204.62
|
| 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 NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$253.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$424.57
|
| 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: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.70
|
| 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 |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$246.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.54
|
| Rate for Payer: Heritage Provider Network Senior |
$382.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$294.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| 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 |
$463.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
|
|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
|
|
HC NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$253.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$424.57
|
| 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: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.70
|
| 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 |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$246.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.54
|
| Rate for Payer: Heritage Provider Network Senior |
$382.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$294.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| 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 |
$463.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$199.47
|
| Rate for Payer: Blue Shield of California EPN |
$159.58
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.41
|
| Rate for Payer: Heritage Provider Network Senior |
$202.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$284.27
|
| Rate for Payer: TriValley Medical Group Senior |
$258.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$163.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$163.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.38
|
| Rate for Payer: Heritage Provider Network Senior |
$221.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$484.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$458.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Senior |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$375.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.59
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$233.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
|
|
HC N-CARDIAC VASC FLOW IMAG
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 78445
|
| Hospital Charge Code |
909301349
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
HC N-CARDIAC VASC FLOW IMAG
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 78445
|
| Hospital Charge Code |
909301349
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$554.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| 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 |
$393.65
|
| Rate for Payer: Blue Shield of California EPN |
$316.56
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.70
|
| 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 |
$674.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$642.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$495.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| 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 |
$778.50
|
| 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 |
$519.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$519.00
|
| 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 NDL 11GX15CM OSTEO-SITE BX SET
|
Facility
|
OP
|
$606.48
|
|
| Hospital Charge Code |
909081705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.77 |
| Max. Negotiated Rate |
$515.51 |
| Rate for Payer: Adventist Health Commercial |
$121.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$324.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.86
|
| Rate for Payer: Blue Shield of California Commercial |
$369.95
|
| Rate for Payer: Blue Shield of California EPN |
$295.96
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$394.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.51
|
| Rate for Payer: Dignity Health Senior |
$515.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.41
|
| Rate for Payer: Heritage Provider Network Senior |
$375.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$289.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$424.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$424.54
|
| Rate for Payer: Multiplan Commercial |
$454.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$303.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$303.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.51
|
| Rate for Payer: Vantage Medical Group Senior |
$515.51
|
|
|
HC NDL 11GX15CM OSTEO-SITE BX SET
|
Facility
|
IP
|
$606.48
|
|
| Hospital Charge Code |
909081705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.77 |
| Max. Negotiated Rate |
$454.86 |
| Rate for Payer: Adventist Health Commercial |
$121.30
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.59
|
| Rate for Payer: Heritage Provider Network Senior |
$410.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Multiplan Commercial |
$454.86
|
|
|
HC NDL 13GX15CM OSTEO-SITE BX SET
|
Facility
|
IP
|
$606.48
|
|
| Hospital Charge Code |
909081704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.77 |
| Max. Negotiated Rate |
$454.86 |
| Rate for Payer: Adventist Health Commercial |
$121.30
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.59
|
| Rate for Payer: Heritage Provider Network Senior |
$410.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Multiplan Commercial |
$454.86
|
|
|
HC NDL 13GX15CM OSTEO-SITE BX SET
|
Facility
|
OP
|
$606.48
|
|
| Hospital Charge Code |
909081704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.77 |
| Max. Negotiated Rate |
$515.51 |
| Rate for Payer: Adventist Health Commercial |
$121.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$324.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.86
|
| Rate for Payer: Blue Shield of California Commercial |
$369.95
|
| Rate for Payer: Blue Shield of California EPN |
$295.96
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$394.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.51
|
| Rate for Payer: Dignity Health Senior |
$515.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.41
|
| Rate for Payer: Heritage Provider Network Senior |
$375.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$289.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$424.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$424.54
|
| Rate for Payer: Multiplan Commercial |
$454.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$303.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$303.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.51
|
| Rate for Payer: Vantage Medical Group Senior |
$515.51
|
|
|
HC NDL HAWKINS II 10.0 CM
|
Facility
|
OP
|
$402.80
|
|
| Hospital Charge Code |
909081738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.91 |
| Max. Negotiated Rate |
$342.38 |
| Rate for Payer: Adventist Health Commercial |
$80.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$215.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$276.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$302.10
|
| Rate for Payer: Blue Shield of California Commercial |
$245.71
|
| Rate for Payer: Blue Shield of California EPN |
$196.57
|
| Rate for Payer: Cash Price |
$221.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$261.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$342.38
|
| Rate for Payer: Dignity Health Senior |
$342.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.33
|
| Rate for Payer: Heritage Provider Network Senior |
$249.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$192.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$281.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$281.96
|
| Rate for Payer: Multiplan Commercial |
$302.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$201.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$201.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$342.38
|
| Rate for Payer: Vantage Medical Group Senior |
$342.38
|
|
|
HC NDL HAWKINS II 10.0 CM
|
Facility
|
IP
|
$402.80
|
|
| Hospital Charge Code |
909081738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.91 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Adventist Health Commercial |
$80.56
|
| Rate for Payer: Cash Price |
$221.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.70
|
| Rate for Payer: Heritage Provider Network Senior |
$272.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.70
|
| Rate for Payer: Multiplan Commercial |
$302.10
|
|
|
HC NDL HAWKINS II 5.0 CM
|
Facility
|
IP
|
$201.40
|
|
| Hospital Charge Code |
909081736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Adventist Health Commercial |
$40.28
|
| Rate for Payer: Cash Price |
$110.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.35
|
| Rate for Payer: Heritage Provider Network Senior |
$136.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.35
|
| Rate for Payer: Multiplan Commercial |
$151.05
|
|
