|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$225.64 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$941.40
|
| Rate for Payer: Blue Shield of California Commercial |
$927.28
|
| Rate for Payer: Blue Shield of California EPN |
$735.86
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| 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 |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,176.75
|
| 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 |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| 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 |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$784.50
|
| Rate for Payer: United Healthcare HMO Rider |
$784.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$784.50
|
| 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 LOCALIZATION DEVICE MRI
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$3,503.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$464.74 |
| 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 |
$1,318.60
|
| 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 |
$2,101.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: Cigna of CA PPO |
$2,592.22
|
| 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 |
$2,977.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,101.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,627.25
|
| 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 |
$2,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.72
|
| 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 |
$2,802.40
|
| Rate for Payer: Networks By Design Commercial |
$2,276.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,977.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,101.80
|
| 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 LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
IP
|
$3,503.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$840.72 |
| Max. Negotiated Rate |
$2,977.55 |
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.20
|
| Rate for Payer: Galaxy Health WC |
$2,977.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,101.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,334.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.72
|
| Rate for Payer: Multiplan Commercial |
$2,802.40
|
| Rate for Payer: Networks By Design Commercial |
$2,276.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,977.55
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.56 |
| 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 |
$1,318.60
|
| 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 |
$941.40
|
| Rate for Payer: Blue Shield of California Commercial |
$927.28
|
| Rate for Payer: Blue Shield of California EPN |
$735.86
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| 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 |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,176.75
|
| 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 |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| 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 |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$784.50
|
| Rate for Payer: United Healthcare HMO Rider |
$784.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$784.50
|
| 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 LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
IP
|
$1,307.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.80
|
| Rate for Payer: Galaxy Health WC |
$1,110.95
|
| Rate for Payer: Global Benefits Group Commercial |
$784.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.68
|
| Rate for Payer: Multiplan Commercial |
$1,045.60
|
| Rate for Payer: Networks By Design Commercial |
$849.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.95
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
OP
|
$1,307.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$313.68 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$784.20
|
| Rate for Payer: Blue Shield of California Commercial |
$772.44
|
| Rate for Payer: Blue Shield of California EPN |
$612.98
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cigna of CA HMO |
$836.48
|
| Rate for Payer: Cigna of CA PPO |
$967.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$1,110.95
|
| Rate for Payer: Global Benefits Group Commercial |
$784.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$980.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,045.60
|
| Rate for Payer: Networks By Design Commercial |
$849.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$784.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$784.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$653.50
|
| Rate for Payer: United Healthcare All Other HMO |
$653.50
|
| Rate for Payer: United Healthcare HMO Rider |
$653.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$653.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BREAST TOMO
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,606.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,275.21
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Media |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,039.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,606.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,275.21
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Media |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,039.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC BRISK PROFILE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$178.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.52
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California EPN |
$41.98
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Media |
$24.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Transplant |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$40.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
IP
|
$1,657.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$397.68 |
| Max. Negotiated Rate |
$1,408.45 |
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.80
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.68
|
| Rate for Payer: Multiplan Commercial |
$1,325.60
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
OP
|
$1,657.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$397.68 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,408.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$911.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$911.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$994.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cigna of CA PPO |
$1,226.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,408.45
|
| Rate for Payer: Dignity Health Media |
$1,408.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,408.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$662.80
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,242.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.68
|
| Rate for Payer: Multiplan Commercial |
$1,325.60
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.20
|
| 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 |
$1,408.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,408.45
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,581.84 |
| Max. Negotiated Rate |
$5,602.35 |
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,511.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$4,284.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.76 |
| Max. Negotiated Rate |
$5,602.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,625.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,625.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,954.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA PPO |
$4,877.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Dignity Health Media |
$5,602.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,602.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,943.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$4,284.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,954.60
|
| 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 |
$5,602.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,602.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,602.35
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,581.84 |
| Max. Negotiated Rate |
$5,602.35 |
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,511.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$4,284.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,571.07 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,954.60
|
| 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 |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA PPO |
$4,877.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,943.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$4,284.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,954.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,581.84 |
| Max. Negotiated Rate |
$5,602.35 |
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,511.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$4,284.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,581.84 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,954.60
|
| 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 |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA PPO |
$4,877.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,943.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,668.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$4,284.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,954.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$5,551.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,332.24 |
| Max. Negotiated Rate |
$4,718.35 |
| Rate for Payer: Cash Price |
$2,497.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,220.40
|
| Rate for Payer: Galaxy Health WC |
$4,718.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,702.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,114.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$4,440.80
|
| Rate for Payer: Networks By Design Commercial |
$3,608.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,718.35
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$5,551.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.13 |
| 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 |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,330.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,091.09
|
| Rate for Payer: Blue Shield of California EPN |
$3,241.78
|
| Rate for Payer: Cash Price |
$2,497.95
|
| Rate for Payer: Cash Price |
$2,497.95
|
| Rate for Payer: Cigna of CA HMO |
$3,552.64
|
| Rate for Payer: Cigna of CA PPO |
$4,107.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$4,718.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,330.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,163.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,702.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$4,440.80
|
| Rate for Payer: Networks By Design Commercial |
$3,608.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,718.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,775.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,775.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,775.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,775.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
OP
|
$10,147.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.39 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,088.20
|
| 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 |
$4,566.15
|
| Rate for Payer: Cash Price |
$4,566.15
|
| Rate for Payer: Cigna of CA PPO |
$7,508.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Galaxy Health WC |
$8,624.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,088.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,610.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,024.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,768.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,435.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan Commercial |
$8,117.60
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Networks By Design Commercial |
$6,595.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,624.95
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,088.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
IP
|
$10,147.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,435.28 |
| Max. Negotiated Rate |
$8,624.95 |
| Rate for Payer: Cash Price |
$4,566.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,058.80
|
| Rate for Payer: Galaxy Health WC |
$8,624.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,088.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,768.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,866.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,435.28
|
| Rate for Payer: Multiplan Commercial |
$8,117.60
|
| Rate for Payer: Networks By Design Commercial |
$6,595.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,624.95
|
|
