|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$910.56 |
| Max. Negotiated Rate |
$3,224.90 |
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,517.60
|
| Rate for Payer: Galaxy Health WC |
$3,224.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,276.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,445.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.56
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Networks By Design Commercial |
$2,466.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,224.90
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$3,794.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.20 |
| 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 |
$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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,276.40
|
| 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 |
$1,707.30
|
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: Cigna of CA PPO |
$2,807.56
|
| 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 |
$3,224.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,276.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,845.50
|
| 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 |
$2,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.56
|
| 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 |
$3,035.20
|
| Rate for Payer: Networks By Design Commercial |
$2,466.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,224.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,276.40
|
| 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 |
$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 BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$3,328.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$2,828.80 |
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$3,328.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,996.80
|
| 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 |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$2,462.72
|
| 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 |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,496.00
|
| 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 |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| 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 |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,996.80
|
| 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 |
$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 BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$3,993.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.14 |
| 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 |
$3,394.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,196.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,196.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,395.80
|
| 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 |
$1,796.85
|
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: Cigna of CA PPO |
$2,954.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,394.05
|
| Rate for Payer: Dignity Health Media |
$3,394.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,394.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,597.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,597.20
|
| Rate for Payer: Galaxy Health WC |
$3,394.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,395.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,994.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,663.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.32
|
| Rate for Payer: Multiplan Commercial |
$3,194.40
|
| Rate for Payer: Networks By Design Commercial |
$2,595.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,394.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,395.80
|
| 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 |
$3,394.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,394.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,394.05
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$3,993.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$958.32 |
| Max. Negotiated Rate |
$3,394.05 |
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,597.20
|
| Rate for Payer: Galaxy Health WC |
$3,394.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,395.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,663.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,521.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.32
|
| Rate for Payer: Multiplan Commercial |
$3,194.40
|
| Rate for Payer: Networks By Design Commercial |
$2,595.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,394.05
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$3,328.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| 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 |
$2,828.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,830.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,830.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,996.80
|
| 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 |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$2,462.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,828.80
|
| Rate for Payer: Dignity Health Media |
$2,828.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,496.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,996.80
|
| 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 |
$2,828.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,828.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,828.80
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$3,328.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$2,828.80 |
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,664.00
|
| Rate for Payer: Galaxy Health WC |
$3,536.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,496.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,774.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$3,328.00
|
| Rate for Payer: Networks By Design Commercial |
$2,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,536.00
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$962.73 |
| 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 |
$3,536.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,288.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,288.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,458.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,951.04
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$2,662.40
|
| Rate for Payer: Cigna of CA PPO |
$3,078.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,536.00
|
| Rate for Payer: Dignity Health Media |
$3,536.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,536.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,664.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,664.00
|
| Rate for Payer: Galaxy Health WC |
$3,536.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,496.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,774.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$962.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$3,328.00
|
| Rate for Payer: Networks By Design Commercial |
$2,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,536.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,496.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,080.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,080.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,080.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,536.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,536.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,536.00
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| 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 |
$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 |
$1,710.60
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cigna of CA PPO |
$2,109.74
|
| 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 |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,138.25
|
| 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 |
$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 |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.24
|
| 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 |
$2,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,710.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.50
|
| 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 BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$684.24 |
| Max. Negotiated Rate |
$2,423.35 |
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.40
|
| Rate for Payer: Galaxy Health WC |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.24
|
| Rate for Payer: Multiplan Commercial |
$2,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$3,337.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$800.88 |
| Max. Negotiated Rate |
$2,836.45 |
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.80
|
| Rate for Payer: Galaxy Health WC |
$2,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,002.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,225.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.88
|
| Rate for Payer: Multiplan Commercial |
$2,669.60
|
| Rate for Payer: Networks By Design Commercial |
$2,169.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,836.45
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$3,337.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| 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 |
$2,002.20
|
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: Cigna of CA PPO |
$2,469.38
|
| 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 |
$2,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,002.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,502.75
|
| 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 |
$2,225.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.88
|
| 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 |
$2,669.60
|
| Rate for Payer: Networks By Design Commercial |
$2,169.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,836.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,668.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,668.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,668.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,668.50
|
| 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 C-14 UREA BREATH TEST ACQ
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.44
|
| Rate for Payer: Blue Distinction Transplant |
$366.00
|
| Rate for Payer: Blue Shield of California Commercial |
$360.51
|
| Rate for Payer: Blue Shield of California EPN |
$286.09
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Media |
$11.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.06
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$457.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$17.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.51
|
| Rate for Payer: United Healthcare All Other HMO |
$28.51
|
| Rate for Payer: United Healthcare HMO Rider |
$28.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$94.41 |
| Max. Negotiated Rate |
$603.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$603.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.71
|
| Rate for Payer: Blue Distinction Transplant |
$355.20
|
| Rate for Payer: Blue Shield of California Commercial |
$349.87
|
| Rate for Payer: Blue Shield of California EPN |
$277.65
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$378.88
|
| Rate for Payer: Cigna of CA PPO |
$438.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.62
|
| Rate for Payer: Dignity Health Media |
$94.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$94.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$94.41
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$444.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$154.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$152.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.51
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.22
|
| Rate for Payer: United Healthcare All Other HMO |
$244.22
|
| Rate for Payer: United Healthcare HMO Rider |
$244.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Vantage Medical Group Senior |
$94.41
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$142.08 |
| Max. Negotiated Rate |
$503.20 |
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.08
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$124.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.69
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Media |
$13.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.68
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.44
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CAFFEINE SERUM
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Distinction Transplant |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.42
|
| Rate for Payer: Blue Shield of California EPN |
$22.53
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CALCIUM TOTAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$46.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.93
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Media |
$5.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.16
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Distinction Transplant |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$65.25
|
| Rate for Payer: Blue Shield of California EPN |
$51.71
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CANTHOTOMY
|
Facility
|
IP
|
$5,079.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,218.96 |
| Max. Negotiated Rate |
$4,317.15 |
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,031.60
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,387.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,935.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
|
|
HC CANTHOTOMY
|
Facility
|
OP
|
$5,079.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.14 |
| 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 |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,047.40
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cigna of CA PPO |
$3,758.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,809.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| 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 |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,387.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,047.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,539.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,539.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,539.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC CAPD DAILY TREATMENT
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000101
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$255.36 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.36
|
| Rate for Payer: Multiplan Commercial |
$851.20
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
