|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.53 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Multiplan Commercial |
$1,179.00
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.35 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$840.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,079.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,336.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,179.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.45
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,021.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,336.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,336.20
|
| Rate for Payer: Dignity Health Senior |
$1,336.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,021.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$973.07
|
| Rate for Payer: Heritage Provider Network Senior |
$973.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$749.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,100.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,100.40
|
| Rate for Payer: Multiplan Commercial |
$1,179.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$786.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$786.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,336.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,336.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,336.20
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$866.80
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$975.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
988132551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$924.55 |
| Max. Negotiated Rate |
$3,831.00 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,458.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,458.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.00
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
988132551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,509.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,320.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,458.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,458.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,436.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,837.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,691.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.26 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,066.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,066.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$751.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$567.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$521.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.26 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Cash Price |
$866.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,066.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
|
|
HC TUBE TRACH BIVONA FLEXTEND NEO
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Blue Shield of California Commercial |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND NEO
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND PED
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Blue Shield of California Commercial |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND PED
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Blue Shield of California Commercial |
$108.58
|
| Rate for Payer: Blue Shield of California EPN |
$86.86
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Senior |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$89.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
OP
|
$3,199.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$307.31 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$639.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,709.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,197.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$909.89
|
| Rate for Payer: Blue Shield of California EPN |
$731.70
|
| Rate for Payer: Cash Price |
$1,759.45
|
| Rate for Payer: Cash Price |
$1,759.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,079.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,079.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,980.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,980.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,525.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$2,399.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,599.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,599.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
IP
|
$3,199.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$579.02 |
| Max. Negotiated Rate |
$2,399.25 |
| Rate for Payer: Adventist Health Commercial |
$639.80
|
| Rate for Payer: Cash Price |
$1,759.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,165.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,165.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.75
|
| Rate for Payer: Multiplan Commercial |
$2,399.25
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$546.62 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$604.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,614.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,074.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.52
|
| Rate for Payer: Cash Price |
$1,661.00
|
| Rate for Payer: Cash Price |
$1,661.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,963.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,963.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,869.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,869.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,440.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$755.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$2,265.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,510.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,510.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$546.62 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Adventist Health Commercial |
$604.00
|
| Rate for Payer: Cash Price |
$1,661.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,044.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,044.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$755.00
|
| Rate for Payer: Multiplan Commercial |
$2,265.00
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$625.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Blue Shield of California Commercial |
$713.70
|
| Rate for Payer: Blue Shield of California EPN |
$570.96
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Senior |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Blue Shield of California Commercial |
$56.73
|
| Rate for Payer: Blue Shield of California EPN |
$45.38
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Senior |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.10
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC T-WAVE ALTERNANS
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$323.99 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Cash Price |
$984.50
|
| 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 |
$323.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
|
|
HC T-WAVE ALTERNANS
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$956.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,229.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$984.50
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Cash Price |
$984.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,163.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,163.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,108.01
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC U1RNP AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
