|
HC TRACTION MECHANICAL MCAL
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| 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 |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: IEHP Medi-Cal |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| 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 |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: IEHP Medi-Cal |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
IP
|
$796.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.85
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
OP
|
$796.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$494.32
|
| Rate for Payer: Blue Shield of California EPN |
$467.25
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.72
|
| Rate for Payer: Heritage Provider Network Senior |
$492.72
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$547.29
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$398.00
|
| Rate for Payer: TriValley Medical Group Senior |
$398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
IP
|
$796.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.85
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
OP
|
$796.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$494.32
|
| Rate for Payer: Blue Shield of California EPN |
$467.25
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.72
|
| Rate for Payer: Heritage Provider Network Senior |
$492.72
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$547.29
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$398.00
|
| Rate for Payer: TriValley Medical Group Senior |
$398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
OP
|
$3,045.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$609.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,091.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,890.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,787.42
|
| Rate for Payer: Cash Price |
$1,370.25
|
| Rate for Payer: Cash Price |
$1,370.25
|
| Rate for Payer: Cash Price |
$1,370.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,979.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,884.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,884.86
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$328.72
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$2,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
IP
|
$3,045.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$551.14 |
| Max. Negotiated Rate |
$2,283.75 |
| Rate for Payer: Adventist Health Commercial |
$609.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,091.92
|
| Rate for Payer: Cash Price |
$1,370.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,061.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,061.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.25
|
| Rate for Payer: Multiplan Commercial |
$2,283.75
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,334.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,510.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,059.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,705.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,784.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,334.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,334.10
|
| Rate for Payer: Dignity Health Senior |
$2,334.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,699.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,699.77
|
| Rate for Payer: IEHP Medi-Cal |
$92.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,323.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,373.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,373.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,334.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,334.10
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.03 |
| Max. Negotiated Rate |
$2,059.50 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,334.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,510.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,059.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,705.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,784.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,334.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,334.10
|
| Rate for Payer: Dignity Health Senior |
$2,334.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,699.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,699.77
|
| Rate for Payer: IEHP Medi-Cal |
$114.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,323.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,373.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,373.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,334.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,334.10
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.03 |
| Max. Negotiated Rate |
$2,059.50 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
|
|
HC TRANSBRONCHIAL W/NEEDLE BIOPSY
|
Facility
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
900803508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.03 |
| Max. Negotiated Rate |
$2,059.50 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
|
|
HC TRANSBRONCHIAL W/NEEDLE BIOPSY
|
Facility
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
900803508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,784.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,699.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,755.08
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$290.39
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
OP
|
$36,376.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906812218
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,644.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,516.74
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$942.12
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
IP
|
$36,376.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906812218
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,282.00 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
OP
|
$38,623.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906820084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,724.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,534.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,104.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,907.64
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$942.12
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,990.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$28,967.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
IP
|
$38,623.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906820084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$28,967.25 |
| Rate for Payer: Adventist Health Commercial |
$7,724.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,534.00
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,990.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.75
|
| Rate for Payer: Multiplan Commercial |
$28,967.25
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
IP
|
$36,376.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906812219
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,282.00 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
OP
|
$27,956.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906820085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,186.72 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$5,591.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,205.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$12,580.20
|
| Rate for Payer: Cash Price |
$12,580.20
|
| Rate for Payer: Cash Price |
$12,580.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,171.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,304.76
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$1,186.72
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,060.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,989.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$20,967.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
OP
|
$36,376.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906812219
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,186.72 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,644.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,516.74
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$1,186.72
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
IP
|
$27,956.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906820085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$20,967.00 |
| Rate for Payer: Adventist Health Commercial |
$5,591.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,205.77
|
| Rate for Payer: Cash Price |
$12,580.20
|
| Rate for Payer: Cash Price |
$12,580.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,060.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,989.00
|
| Rate for Payer: Multiplan Commercial |
$20,967.00
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
IP
|
$5,911.00
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
909081664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,069.89 |
| Max. Negotiated Rate |
$4,433.25 |
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,060.86
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,001.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,001.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,477.75
|
| Rate for Payer: Multiplan Commercial |
$4,433.25
|
|
