|
HC NASAL/SINUS ENDOSCOPY W/BX
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
950442337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,942.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,095.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,947.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,349.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$861.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC NASAL/SINUS ENDOSCOPY W/BX
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
950442337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.92 |
| Max. Negotiated Rate |
$3,571.50 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.73
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,223.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,223.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$861.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.50
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$291.09
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$279.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$706.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$215.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
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 |
$81.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$279.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$214.70
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| 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) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$215.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Senior |
$271.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
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: Aetna of CA Non-Gatekeeper |
$291.09
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.02
|
| Rate for Payer: Blue Shield of California EPN |
$339.82
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$584.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| 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) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$428.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$539.40
|
| Rate for Payer: TriValley Medical Group Senior |
$539.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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: Aetna of CA Non-Gatekeeper |
$578.96
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$608.62
|
| Rate for Payer: Heritage Provider Network Senior |
$608.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.75
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
|
|
HC NASOPHARYNGOGRAM
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Adventist Health Commercial |
$131.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.94
|
| 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 |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$426.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$312.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$422.46
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.11
|
| Rate for Payer: Heritage Provider Network Senior |
$444.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
|
|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$293.55
|
| Rate for Payer: Blue Shield of California EPN |
$233.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.73
|
| 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) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$294.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Senior |
$370.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
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: Aetna of CA Non-Gatekeeper |
$397.99
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$253.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.73
|
| 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) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$294.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| 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 |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
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: Aetna of CA Non-Gatekeeper |
$397.99
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$397.99
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$418.39
|
| Rate for Payer: Heritage Provider Network Senior |
$418.39
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$111.86 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$253.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.73
|
| 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) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$294.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| 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 |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| 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) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$155.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$309.80
|
| Rate for Payer: TriValley Medical Group Senior |
$281.64
|
| 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 |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
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: Aetna of CA Non-Gatekeeper |
$210.59
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.38
|
| Rate for Payer: Heritage Provider Network Senior |
$221.38
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$454.02
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$435.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$334.88
|
| Rate for Payer: Blue Shield of California EPN |
$266.49
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$458.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| 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) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$336.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Senior |
$423.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
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 Non-Gatekeeper |
$641.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.21
|
| 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 |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| 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) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$495.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$519.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$519.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$668.47
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
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 |
$390.57
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$374.80
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$303.36
|
| 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 |
$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 Medicare Advantage |
$515.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.41
|
| Rate for Payer: Heritage Provider Network Senior |
$375.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$289.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$390.57
|
| 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 Foundation Hospitals Medi-Cal |
$109.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Multiplan Commercial |
$454.86
|
|
