|
HC TRACH CHANGE
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$716.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$580.23
|
| Rate for Payer: Blue Shield of California Commercial |
$707.60
|
| Rate for Payer: Blue Shield of California EPN |
$566.08
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$754.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$718.04
|
| Rate for Payer: Heritage Provider Network Senior |
$718.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$553.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$580.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$580.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC TRACH CHANGE
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$747.04
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$785.32
|
| Rate for Payer: Heritage Provider Network Senior |
$785.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
IP
|
$3,206.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$580.29 |
| Max. Negotiated Rate |
$2,404.50 |
| Rate for Payer: Adventist Health Commercial |
$641.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,064.66
|
| Rate for Payer: Cash Price |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,170.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,170.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.50
|
| Rate for Payer: Multiplan Commercial |
$2,404.50
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
OP
|
$3,206.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$580.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$641.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,981.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,442.70
|
| Rate for Payer: Cash Price |
$1,442.70
|
| Rate for Payer: Cash Price |
$1,442.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,083.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,984.51
|
| Rate for Payer: Heritage Provider Network Senior |
$853.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,317.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$2,404.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$763.04
|
| Rate for Payer: TriValley Medical Group Senior |
$763.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,061.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,500.75
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,167.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,064.36
|
| Rate for Payer: Heritage Provider Network Senior |
$374.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$578.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$603.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$2,501.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.09
|
| Rate for Payer: TriValley Medical Group Senior |
$335.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,061.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,584.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,260.63
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,167.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,590.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$603.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$2,501.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$603.63 |
| Max. Negotiated Rate |
$2,501.25 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,147.74
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$603.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.75
|
| Rate for Payer: Multiplan Commercial |
$2,501.25
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.63 |
| Max. Negotiated Rate |
$2,501.25 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,147.74
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$603.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.75
|
| Rate for Payer: Multiplan Commercial |
$2,501.25
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
OP
|
$7,151.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,294.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,430.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,419.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,396.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,703.08
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,648.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,841.23
|
| Rate for Payer: Heritage Provider Network Senior |
$4,841.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,411.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,294.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$5,363.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,290.60
|
| Rate for Payer: TriValley Medical Group Senior |
$4,290.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
IP
|
$7,151.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,294.33 |
| Max. Negotiated Rate |
$5,363.25 |
| Rate for Payer: Adventist Health Commercial |
$1,430.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,605.24
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,841.23
|
| Rate for Payer: Heritage Provider Network Senior |
$4,841.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.75
|
| Rate for Payer: Multiplan Commercial |
$5,363.25
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$8,632.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,562.39 |
| Max. Negotiated Rate |
$6,474.00 |
| Rate for Payer: Adventist Health Commercial |
$1,726.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,559.01
|
| Rate for Payer: Cash Price |
$3,884.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,843.86
|
| Rate for Payer: Heritage Provider Network Senior |
$5,843.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,562.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,158.00
|
| Rate for Payer: Multiplan Commercial |
$6,474.00
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$8,632.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,726.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,334.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$3,884.40
|
| Rate for Payer: Cash Price |
$3,884.40
|
| Rate for Payer: Cash Price |
$3,884.40
|
| Rate for Payer: Cash Price |
$3,884.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,610.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,343.21
|
| Rate for Payer: Heritage Provider Network Senior |
$5,343.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,117.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,562.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,158.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$6,474.00
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
IP
|
$10,460.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$7,845.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,736.24
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,893.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
OP
|
$10,460.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,464.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,968.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,953.88
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,799.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,989.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,893.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,276.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6,276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$467.40
|
| Rate for Payer: Blue Shield of California EPN |
$371.95
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$639.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.17
|
| Rate for Payer: Heritage Provider Network Senior |
$666.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$469.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Senior |
$590.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.70
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.17
|
| Rate for Payer: Heritage Provider Network Senior |
$666.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$639.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.10
|
| Rate for Payer: Heritage Provider Network Senior |
$609.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$469.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.70
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.17
|
| Rate for Payer: Heritage Provider Network Senior |
$666.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
|
|
HC TRACKER CATH
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$598.92
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$629.61
|
| Rate for Payer: Heritage Provider Network Senior |
$629.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
|
|
HC TRACKER CATH
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$574.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.19
|
| Rate for Payer: Blue Shield of California Commercial |
$567.30
|
| Rate for Payer: Blue Shield of California EPN |
$453.84
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$604.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.67
|
| Rate for Payer: Heritage Provider Network Senior |
$575.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$443.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$465.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$465.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC TRACKER - GUIDEWIRE
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$390.26
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.26
|
| Rate for Payer: Heritage Provider Network Senior |
$410.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
|
|
HC TRACKER - GUIDEWIRE
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$515.10 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$374.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.12
|
| Rate for Payer: Blue Shield of California Commercial |
$369.66
|
| Rate for Payer: Blue Shield of California EPN |
$295.73
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$515.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.11
|
| Rate for Payer: Heritage Provider Network Senior |
$375.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$289.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$424.20
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$303.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.10
|
| Rate for Payer: Vantage Medical Group Senior |
$515.10
|
|
|
HC TRACKER INFUSION KIT
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.79 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$739.31
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$777.20
|
| Rate for Payer: Heritage Provider Network Senior |
$777.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$861.00
|
|
|
HC TRACKER INFUSION KIT
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.79 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$709.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$975.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$631.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$861.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$574.23
|
| Rate for Payer: Blue Shield of California Commercial |
$700.28
|
| Rate for Payer: Blue Shield of California EPN |
$560.22
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$746.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$975.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$975.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$975.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$710.61
|
| Rate for Payer: Heritage Provider Network Senior |
$710.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$547.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$803.60
|
| Rate for Payer: Multiplan Commercial |
$861.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$574.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$574.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$975.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$975.80
|
| Rate for Payer: Vantage Medical Group Senior |
$975.80
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
905103103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.48
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.15
|
| Rate for Payer: Heritage Provider Network Senior |
$75.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
|
