|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$225.32 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Adventist Health Commercial |
$334.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,096.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,026.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,023.26
|
| Rate for Payer: Blue Shield of California EPN |
$675.49
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cigna of CA HMO |
$1,070.08
|
| Rate for Payer: Cigna of CA PPO |
$1,237.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,003.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Adventist Health Commercial |
$334.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.80
|
| Rate for Payer: EPIC Health Plan Senior |
$668.80
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,034.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.28
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$267.42 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,371.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,284.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,279.69
|
| Rate for Payer: Blue Shield of California EPN |
$844.76
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cigna of CA HMO |
$1,338.24
|
| Rate for Payer: Cigna of CA PPO |
$1,547.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
IP
|
$4,389.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$877.80 |
| Max. Negotiated Rate |
$3,730.65 |
| Rate for Payer: Adventist Health Commercial |
$877.80
|
| Rate for Payer: Cash Price |
$1,975.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,755.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,755.60
|
| Rate for Payer: Galaxy Health WC |
$3,730.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,633.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,927.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,716.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.36
|
| Rate for Payer: Multiplan Commercial |
$3,511.20
|
| Rate for Payer: Networks By Design Commercial |
$2,852.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,730.65
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
OP
|
$4,389.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$877.80 |
| Max. Negotiated Rate |
$3,730.65 |
| Rate for Payer: Adventist Health Commercial |
$877.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,878.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,730.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,413.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,291.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,695.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,686.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,773.16
|
| Rate for Payer: Cash Price |
$1,975.05
|
| Rate for Payer: Cigna of CA HMO |
$2,808.96
|
| Rate for Payer: Cigna of CA PPO |
$3,247.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,730.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,730.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,730.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,755.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,755.60
|
| Rate for Payer: Galaxy Health WC |
$3,730.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,633.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,927.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,716.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,072.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,072.30
|
| Rate for Payer: Multiplan Commercial |
$3,511.20
|
| Rate for Payer: Networks By Design Commercial |
$2,852.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,730.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,633.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,633.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,194.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,194.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,194.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,194.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,730.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,730.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3,730.65
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$8,788.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$7,979.39 |
| Rate for Payer: Adventist Health Commercial |
$1,757.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Cigna of CA HMO |
$5,624.32
|
| Rate for Payer: Cigna of CA PPO |
$6,503.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$7,469.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,109.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$7,030.40
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$5,712.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,469.80
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,272.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,394.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,394.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,394.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,394.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$8,788.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$7,469.80 |
| Rate for Payer: Adventist Health Commercial |
$1,757.60
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,515.20
|
| Rate for Payer: Galaxy Health WC |
$7,469.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,348.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,439.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,109.12
|
| Rate for Payer: Multiplan Commercial |
$7,030.40
|
| Rate for Payer: Networks By Design Commercial |
$5,712.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,469.80
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.80
|
| Rate for Payer: EPIC Health Plan Senior |
$478.80
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$798.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$740.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$658.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$897.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cigna of CA HMO |
$766.08
|
| Rate for Payer: Cigna of CA PPO |
$885.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,017.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,017.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.80
|
| Rate for Payer: EPIC Health Plan Senior |
$478.80
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$798.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$740.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$837.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$837.90
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,017.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,017.45
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna of CA HMO |
$1,231.36
|
| Rate for Payer: Cigna of CA PPO |
$1,423.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$1,635.40 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Senior |
$769.60
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,190.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna of CA HMO |
$1,231.36
|
| Rate for Payer: Cigna of CA PPO |
$1,423.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$1,635.40 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Senior |
$769.60
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,190.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$199.52 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$774.79
|
| Rate for Payer: Blue Shield of California EPN |
$511.46
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna of CA HMO |
$810.24
|
| Rate for Payer: Cigna of CA PPO |
$936.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$1,076.10 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.40
|
| Rate for Payer: EPIC Health Plan Senior |
$506.40
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.93 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna of CA HMO |
$1,809.92
|
| Rate for Payer: Cigna of CA PPO |
$2,092.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,838.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$1,076.10 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.40
|
| Rate for Payer: EPIC Health Plan Senior |
$506.40
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$774.79
|
| Rate for Payer: Blue Shield of California EPN |
$511.46
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna of CA HMO |
$810.24
|
| Rate for Payer: Cigna of CA PPO |
$936.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$799.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$896.75 |
| Rate for Payer: Adventist Health Commercial |
$211.00
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$422.00
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.20
|
| Rate for Payer: Multiplan Commercial |
$844.00
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$211.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$645.66
|
| Rate for Payer: Blue Shield of California EPN |
$426.22
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cigna of CA HMO |
$675.20
|
| Rate for Payer: Cigna of CA PPO |
$780.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$362.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$844.00
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$527.50
|
| Rate for Payer: United Healthcare All Other HMO |
$527.50
|
| Rate for Payer: United Healthcare HMO Rider |
$527.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$527.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
915358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.65
|
| Rate for Payer: Blue Shield of California Commercial |
$360.14
|
| Rate for Payer: Blue Shield of California EPN |
$237.17
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
905358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
|
|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
905358020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$414.80 |
| Rate for Payer: Adventist Health Commercial |
$200.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.65
|
| Rate for Payer: Blue Shield of California Commercial |
$360.14
|
| Rate for Payer: Blue Shield of California EPN |
$237.17
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.60
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.15
|
| Rate for Payer: United Healthcare All Other HMO |
$178.27
|
| Rate for Payer: United Healthcare HMO Rider |
$174.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
