|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
IP
|
$565.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$423.75 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.50
|
| Rate for Payer: Heritage Provider Network Senior |
$382.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
|
|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
OP
|
$565.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: Dignity Health Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.50
|
| Rate for Payer: Heritage Provider Network Senior |
$382.50
|
| Rate for Payer: Humana Medicare |
$247.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$272.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$205.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
IP
|
$565.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$423.75 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.50
|
| Rate for Payer: Heritage Provider Network Senior |
$382.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
|
|
HC NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
OP
|
$565.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: Dignity Health Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.74
|
| Rate for Payer: Heritage Provider Network Senior |
$349.74
|
| Rate for Payer: Humana Medicare |
$247.49
|
| Rate for Payer: IEHP Medi-Cal |
$65.19
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$470.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.55
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.82
|
| Rate for Payer: Heritage Provider Network Senior |
$184.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$169.53
|
| Rate for Payer: Blue Shield of California EPN |
$160.25
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$177.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.99
|
| Rate for Payer: Heritage Provider Network Senior |
$168.99
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: IEHP Medi-Cal |
$78.98
|
| Rate for Payer: IEHP Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$293.14
|
| Rate for Payer: TriValley Medical Group Senior |
$266.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
IP
|
$645.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$483.75 |
| Rate for Payer: Adventist Health Commercial |
$129.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.12
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.66
|
| Rate for Payer: Heritage Provider Network Senior |
$436.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
OP
|
$645.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$129.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.66
|
| Rate for Payer: Heritage Provider Network Senior |
$436.66
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$310.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$215.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC N-CARDIAC VASC FLOW IMAG
|
Facility
IP
|
$951.00
|
|
|
Service Code
|
CPT 78445
|
| Hospital Charge Code |
909301349
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$713.25 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.34
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.83
|
| Rate for Payer: Heritage Provider Network Senior |
$643.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
|
|
HC N-CARDIAC VASC FLOW IMAG
|
Facility
OP
|
$951.00
|
|
|
Service Code
|
CPT 78445
|
| Hospital Charge Code |
909301349
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$979.11 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$328.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$382.17
|
| Rate for Payer: Blue Shield of California EPN |
$217.33
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$618.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.67
|
| Rate for Payer: Heritage Provider Network Senior |
$588.67
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$188.49
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$416.65
|
| Rate for Payer: Cash Price |
$272.92
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$515.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$333.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$454.86
|
| Rate for Payer: Blue Shield of California Commercial |
$376.62
|
| Rate for Payer: Blue Shield of California EPN |
$356.00
|
| Rate for Payer: Cash Price |
$272.92
|
| 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 |
$292.32
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.51
|
| Rate for Payer: Vantage Medical Group Senior |
$515.51
|
|
|
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: Aetna of CA Non-Gatekeeper |
$416.65
|
| Rate for Payer: Cash Price |
$272.92
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$515.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$333.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$454.86
|
| Rate for Payer: Blue Shield of California Commercial |
$376.62
|
| Rate for Payer: Blue Shield of California EPN |
$356.00
|
| Rate for Payer: Cash Price |
$272.92
|
| 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 |
$292.32
|
| 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
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$342.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$221.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$302.10
|
| Rate for Payer: Blue Shield of California Commercial |
$250.14
|
| Rate for Payer: Blue Shield of California EPN |
$236.44
|
| Rate for Payer: Cash Price |
$181.26
|
| 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 |
$194.15
|
| 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
|
| 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: Aetna of CA Non-Gatekeeper |
$276.72
|
| Rate for Payer: Cash Price |
$181.26
|
| 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: Aetna of CA Non-Gatekeeper |
$138.36
|
| Rate for Payer: Cash Price |
$90.63
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$151.05
|
| Rate for Payer: Blue Shield of California Commercial |
$125.07
|
| Rate for Payer: Blue Shield of California EPN |
$118.22
|
| Rate for Payer: Cash Price |
$90.63
|
| 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 |
$97.07
|
| 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: Multiplan Commercial |
$151.05
|
| 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: Aetna of CA Non-Gatekeeper |
$138.36
|
| Rate for Payer: Cash Price |
$90.63
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$151.05
|
| Rate for Payer: Blue Shield of California Commercial |
$125.07
|
| Rate for Payer: Blue Shield of California EPN |
$118.22
|
| Rate for Payer: Cash Price |
$90.63
|
| 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 |
$97.07
|
| 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: Multiplan Commercial |
$151.05
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| 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 |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| 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 18-15
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| 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 |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
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 |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| 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 |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| 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 |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| 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 18-9
|
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: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| 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 |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
