|
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 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 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 |
$259.40
|
| 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 Foundation Hospitals 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 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 Non-Gatekeeper |
$248.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$302.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.48
|
| Rate for Payer: Blue Shield of California Commercial |
$245.71
|
| Rate for Payer: Blue Shield of California EPN |
$196.57
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$342.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.33
|
| Rate for Payer: Heritage Provider Network Senior |
$249.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$192.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$281.96
|
| Rate for Payer: Multiplan Commercial |
$302.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$201.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$201.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$342.38
|
| Rate for Payer: Vantage Medical Group Senior |
$342.38
|
|
|
HC NDL HAWKINS II 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 Non-Gatekeeper |
$124.47
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$100.74
|
| 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 |
$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 Medicare Advantage |
$171.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.67
|
| Rate for Payer: Heritage Provider Network Senior |
$124.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$96.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$129.70
|
| 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 Foundation Hospitals 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
|
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 |
$129.70
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$124.47
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$100.74
|
| 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 |
$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 Medicare Advantage |
$171.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.67
|
| Rate for Payer: Heritage Provider Network Senior |
$124.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$96.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 18-15
|
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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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 18-20
|
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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Cash Price |
$141.72
|
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 18-9
|
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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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
|
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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 20-9
|
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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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 Non-Gatekeeper |
$194.63
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$157.53
|
| 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 |
$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 Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$202.82
|
| 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 Foundation Hospitals Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.73
|
| Rate for Payer: Multiplan Commercial |
$236.21
|
|
