|
HC NDL HAWKINS II 5.0 CM
|
Facility
|
OP
|
$201.40
|
|
| Hospital Charge Code |
909081736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$171.19 |
| Rate for Payer: Adventist Health Commercial |
$40.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.05
|
| Rate for Payer: Blue Shield of California Commercial |
$122.85
|
| Rate for Payer: Blue Shield of California EPN |
$98.28
|
| Rate for Payer: Cash Price |
$110.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.19
|
| Rate for Payer: Dignity Health Senior |
$171.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.67
|
| Rate for Payer: Heritage Provider Network Senior |
$124.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$96.07
|
| 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: Molina Healthcare of CA Medi-Cal |
$140.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.98
|
| Rate for Payer: Multiplan Commercial |
$151.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.19
|
| Rate for Payer: Vantage Medical Group Senior |
$171.19
|
|
|
HC NDL HAWKINS II 7.5 CM
|
Facility
|
IP
|
$201.40
|
|
| Hospital Charge Code |
909081737
|
|
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
|
|
|
HC NDL HAWKINS II 7.5 CM
|
Facility
|
OP
|
$201.40
|
|
| Hospital Charge Code |
909081737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$171.19 |
| Rate for Payer: Adventist Health Commercial |
$40.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.05
|
| Rate for Payer: Blue Shield of California Commercial |
$122.85
|
| Rate for Payer: Blue Shield of California EPN |
$98.28
|
| Rate for Payer: Cash Price |
$110.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.19
|
| Rate for Payer: Dignity Health Senior |
$171.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.67
|
| Rate for Payer: Heritage Provider Network Senior |
$124.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$96.07
|
| 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: Molina Healthcare of CA Medi-Cal |
$140.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.98
|
| Rate for Payer: Multiplan Commercial |
$151.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.19
|
| Rate for Payer: Vantage Medical Group Senior |
$171.19
|
|
|
HC NDL QC COAXIAL BX SET 18-15
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL QC COAXIAL BX SET 18-15
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 18-20
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 18-20
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL QC COAXIAL BX SET 18-9
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL QC COAXIAL BX SET 18-9
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL QC COAXIAL BX SET 20-9
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL QC COAXIAL BX SET 20-9
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 18G 15CM 10MM THROW
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL SET 18G 15CM 10MM THROW
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 18G 9CM 10MM THROW
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL SET 18G 9CM 10MM THROW
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 20G 20CM 20MM THROW
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL SET 20G 20CM 20MM THROW
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 20G 9CM 20MM THROW
|
Facility
|
IP
|
$314.94
|
|
| Hospital Charge Code |
909081732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.21 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
|
HC NDL SET 20G 9CM 20MM THROW
|
Facility
|
OP
|
$314.94
|
|
| Hospital Charge Code |
909081732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.21
|
| Rate for Payer: Blue Shield of California Commercial |
$192.11
|
| Rate for Payer: Blue Shield of California EPN |
$153.69
|
| Rate for Payer: Cash Price |
$173.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.46
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NECK SOFT TISSUE
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
909001201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$241.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.52
|
| 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 |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| 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 |
$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 |
$293.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$279.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| 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 |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| 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 |
$339.00
|
| 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 |
$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 NECK SOFT TISSUE
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
909001201
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
