|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
905103103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.71
|
| Rate for Payer: Heritage Provider Network Senior |
$68.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.70
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.35
|
| Rate for Payer: Vantage Medical Group Senior |
$94.35
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900417012
|
|
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
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900417012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.71
|
| Rate for Payer: Heritage Provider Network Senior |
$68.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.70
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.35
|
| Rate for Payer: Vantage Medical Group Senior |
$94.35
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
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
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.71
|
| Rate for Payer: Heritage Provider Network Senior |
$68.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.70
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.35
|
| Rate for Payer: Vantage Medical Group Senior |
$94.35
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
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
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.71
|
| Rate for Payer: Heritage Provider Network Senior |
$68.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.70
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.35
|
| Rate for Payer: Vantage Medical Group Senior |
$94.35
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$543.51
|
| Rate for Payer: Blue Shield of California EPN |
$434.81
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.53
|
| Rate for Payer: Heritage Provider Network Senior |
$551.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$425.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$445.50
|
| Rate for Payer: TriValley Medical Group Senior |
$445.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$445.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$445.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$668.25 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$573.80
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$603.21
|
| Rate for Payer: Heritage Provider Network Senior |
$603.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.75
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.53 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.10
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.92
|
| Rate for Payer: Heritage Provider Network Senior |
$693.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.25
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$625.25
|
| Rate for Payer: Blue Shield of California EPN |
$500.20
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$634.48
|
| Rate for Payer: Heritage Provider Network Senior |
$634.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$488.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$512.50
|
| Rate for Payer: TriValley Medical Group Senior |
$512.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$512.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$512.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$602.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$665.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,056.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| 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 |
$1,497.15
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,162.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,059.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,111.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$2,495.25
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$665.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,056.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,029.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,623.58
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,162.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,059.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,059.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,586.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$2,495.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,663.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,663.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.19 |
| Max. Negotiated Rate |
$2,495.25 |
| Rate for Payer: Adventist Health Commercial |
$665.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,142.59
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,252.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,252.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.75
|
| Rate for Payer: Multiplan Commercial |
$2,495.25
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$602.19 |
| Max. Negotiated Rate |
$2,495.25 |
| Rate for Payer: Adventist Health Commercial |
$665.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,142.59
|
| Rate for Payer: Cash Price |
$1,497.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,252.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,252.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.75
|
| Rate for Payer: Multiplan Commercial |
$2,495.25
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,650.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,250.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,550.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,550.00
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,650.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,830.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,550.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,500.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,550.00
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,650.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,250.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,550.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,550.00
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,650.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,830.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,550.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,500.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,550.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,550.00
|
|
|
HC TRANSBRONCHIAL W/NEEDLE BIOPSY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
900803508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.00
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,111.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC TRANSBRONCHIAL W/NEEDLE BIOPSY
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
900803508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
