|
HC BONE SURVEY INFANT
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$317.90 |
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC BOTOX INJECTION
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$462.04 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,227.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,784.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,970.40
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,333.68 |
| Max. Negotiated Rate |
$4,723.45 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| Rate for Payer: Multiplan Commercial |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.25 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,205.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,506.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$4,291.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,029.84 |
| Max. Negotiated Rate |
$3,647.35 |
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,716.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,716.40
|
| Rate for Payer: Galaxy Health WC |
$3,647.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,574.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.84
|
| Rate for Payer: Multiplan Commercial |
$3,432.80
|
| Rate for Payer: Networks By Design Commercial |
$2,789.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,647.35
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$4,291.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$3,647.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,290.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,829.02
|
| Rate for Payer: Blue Distinction Transplant |
$2,574.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,012.48
|
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: Cigna of CA HMO |
$2,746.24
|
| Rate for Payer: Cigna of CA PPO |
$3,175.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,647.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,574.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,218.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,432.80
|
| Rate for Payer: Networks By Design Commercial |
$2,789.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,647.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,574.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
OP
|
$4,291.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$3,647.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,290.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,829.02
|
| Rate for Payer: Blue Distinction Transplant |
$2,574.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,012.48
|
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: Cigna of CA HMO |
$2,746.24
|
| Rate for Payer: Cigna of CA PPO |
$3,175.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,647.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,574.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,218.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,432.80
|
| Rate for Payer: Networks By Design Commercial |
$2,789.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,647.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,574.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
IP
|
$4,291.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,029.84 |
| Max. Negotiated Rate |
$3,647.35 |
| Rate for Payer: Cash Price |
$1,930.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,716.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,716.40
|
| Rate for Payer: Galaxy Health WC |
$3,647.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,574.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.84
|
| Rate for Payer: Multiplan Commercial |
$3,432.80
|
| Rate for Payer: Networks By Design Commercial |
$2,789.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,647.35
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$413.14 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$950.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,347.58
|
| Rate for Payer: Blue Distinction Transplant |
$2,354.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,840.36
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cigna of CA HMO |
$2,511.36
|
| Rate for Payer: Cigna of CA PPO |
$2,903.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,943.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,354.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$941.76 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$729.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,033.58
|
| Rate for Payer: Blue Distinction Transplant |
$2,062.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,031.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.95
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO |
$2,199.68
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,577.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,062.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$824.88 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,967.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$472.08 |
| Max. Negotiated Rate |
$1,671.95 |
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.80
|
| Rate for Payer: Galaxy Health WC |
$1,671.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,180.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,311.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$749.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.08
|
| Rate for Payer: Multiplan Commercial |
$1,573.60
|
| Rate for Payer: Networks By Design Commercial |
$1,278.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,671.95
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$254.83 |
| Max. Negotiated Rate |
$1,671.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,083.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,171.94
|
| Rate for Payer: Blue Distinction Transplant |
$1,180.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.50
|
| Rate for Payer: Blue Shield of California EPN |
$922.52
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cigna of CA HMO |
$1,258.88
|
| Rate for Payer: Cigna of CA PPO |
$1,455.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$1,671.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,180.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,475.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,311.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$1,573.60
|
| Rate for Payer: Networks By Design Commercial |
$1,278.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,671.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,180.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
OP
|
$2,460.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$302.44 |
| Max. Negotiated Rate |
$2,091.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,862.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,465.67
|
| Rate for Payer: Blue Distinction Transplant |
$1,476.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,453.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,153.74
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna of CA HMO |
$1,574.40
|
| Rate for Payer: Cigna of CA PPO |
$1,820.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,091.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,476.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,845.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,640.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$1,968.00
|
| Rate for Payer: Networks By Design Commercial |
$1,599.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,091.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,476.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$2,460.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$590.40 |
| Max. Negotiated Rate |
$2,091.00 |
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.00
|
| Rate for Payer: Galaxy Health WC |
$2,091.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,476.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,640.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.40
|
| Rate for Payer: Multiplan Commercial |
$1,968.00
|
| Rate for Payer: Networks By Design Commercial |
$1,599.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,091.00
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$8,991.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,157.84 |
| Max. Negotiated Rate |
$7,642.35 |
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.40
|
| Rate for Payer: Galaxy Health WC |
$7,642.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,997.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,425.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,157.84
|
| Rate for Payer: Multiplan Commercial |
$7,192.80
|
| Rate for Payer: Networks By Design Commercial |
$5,844.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,642.35
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$8,991.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,810.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,394.60
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cigna of CA PPO |
$6,653.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$7,642.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,743.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,810.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,997.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,157.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$7,192.80
|
| Rate for Payer: Networks By Design Commercial |
$5,844.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,642.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,394.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,495.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,495.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,495.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,495.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,041.25 |
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.00
|
| Rate for Payer: Galaxy Health WC |
$1,041.25
|
| Rate for Payer: Global Benefits Group Commercial |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$980.00
|
| Rate for Payer: Networks By Design Commercial |
$796.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,041.25
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,041.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$673.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$673.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$735.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: Cigna of CA PPO |
$906.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,041.25
|
| Rate for Payer: Dignity Health Media |
$1,041.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,041.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.00
|
| Rate for Payer: Galaxy Health WC |
$1,041.25
|
| Rate for Payer: Global Benefits Group Commercial |
$735.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$918.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$980.00
|
| Rate for Payer: Networks By Design Commercial |
$796.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,041.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$735.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,041.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,041.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,041.25
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,181.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,476.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,181.40
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,476.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$984.50
|
| Rate for Payer: United Healthcare All Other HMO |
$984.50
|
| Rate for Payer: United Healthcare HMO Rider |
$984.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
