|
HC BREAST PROS MASECTOMY FORM
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT L8020
|
| Hospital Charge Code |
915358020
|
|
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 SILICONE OR EQUAL
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
905358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.08 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Adventist Health Commercial |
$334.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$612.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.21
|
| Rate for Payer: Blue Shield of California Commercial |
$602.95
|
| Rate for Payer: Blue Shield of California EPN |
$397.06
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$694.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$694.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$694.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$505.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$408.50
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$694.45
|
| Rate for Payer: Vantage Medical Group Senior |
$694.45
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
915358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.08 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Adventist Health Commercial |
$334.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$612.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.21
|
| Rate for Payer: Blue Shield of California Commercial |
$602.95
|
| Rate for Payer: Blue Shield of California EPN |
$397.06
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$694.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$694.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$694.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$505.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$408.50
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$694.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$694.45
|
| Rate for Payer: Vantage Medical Group Senior |
$694.45
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
915358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$163.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$505.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$408.50
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
|
|
HC BREAST PROS SILICONE OR EQUAL
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT L8030
|
| Hospital Charge Code |
905358030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$163.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cash Price |
$367.65
|
| Rate for Payer: Cigna of CA HMO |
$571.90
|
| Rate for Payer: Cigna of CA PPO |
$571.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.80
|
| Rate for Payer: EPIC Health Plan Senior |
$326.80
|
| Rate for Payer: Galaxy Health WC |
$694.45
|
| Rate for Payer: Global Benefits Group Commercial |
$490.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$505.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.08
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Networks By Design Commercial |
$408.50
|
| Rate for Payer: Prime Health Services Commercial |
$694.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.62
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$292.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.57
|
|
|
HC BREAST PROSTHESIS
|
Facility
|
OP
|
$8,525.00
|
|
|
Service Code
|
CPT L8039
|
| Hospital Charge Code |
905358039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,046.00 |
| Max. Negotiated Rate |
$7,246.25 |
| Rate for Payer: Adventist Health Commercial |
$3,495.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,246.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,688.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,937.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6,291.45
|
| Rate for Payer: Blue Shield of California EPN |
$4,143.15
|
| Rate for Payer: Cash Price |
$3,836.25
|
| Rate for Payer: Cigna of CA HMO |
$5,967.50
|
| Rate for Payer: Cigna of CA PPO |
$5,967.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,246.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,246.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,410.00
|
| Rate for Payer: Galaxy Health WC |
$7,246.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,686.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,276.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,967.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,967.50
|
| Rate for Payer: Multiplan Commercial |
$6,820.00
|
| Rate for Payer: Networks By Design Commercial |
$4,262.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,246.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,115.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,115.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,199.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,114.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,046.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,791.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,246.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,246.25
|
|
|
HC BREAST PROSTHESIS
|
Facility
|
IP
|
$8,525.00
|
|
|
Service Code
|
CPT L8039
|
| Hospital Charge Code |
905358039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,705.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,836.25
|
| Rate for Payer: Cash Price |
$3,836.25
|
| Rate for Payer: Cigna of CA HMO |
$5,967.50
|
| Rate for Payer: Cigna of CA PPO |
$5,967.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,410.00
|
| Rate for Payer: Galaxy Health WC |
$7,246.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,686.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,276.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.00
|
| Rate for Payer: Multiplan Commercial |
$6,820.00
|
| Rate for Payer: Networks By Design Commercial |
$4,262.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,246.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,199.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3,114.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,046.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,791.94
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
OP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
915358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$831.38 |
| Rate for Payer: Adventist Health Commercial |
$401.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$733.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.52
|
| Rate for Payer: Blue Shield of California Commercial |
$721.84
|
| Rate for Payer: Blue Shield of California EPN |
$475.36
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$831.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$831.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.67
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$489.05
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$831.38
|
| Rate for Payer: Vantage Medical Group Senior |
$831.38
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
IP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
905358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.62 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$195.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$489.05
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
IP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
915358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.62 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$195.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$489.05
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
|
|
HC BREAST PROSTHESIS W/ADHESIVE
|
Facility
|
OP
|
$978.10
|
|
|
Service Code
|
CPT L8031
|
| Hospital Charge Code |
905358031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$831.38 |
| Rate for Payer: Adventist Health Commercial |
$401.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$537.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$733.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.52
|
| Rate for Payer: Blue Shield of California Commercial |
$721.84
|
| Rate for Payer: Blue Shield of California EPN |
$475.36
|
| Rate for Payer: Cash Price |
$440.15
|
| Rate for Payer: Cigna of CA HMO |
$684.67
|
| Rate for Payer: Cigna of CA PPO |
$684.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$831.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$831.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.24
|
| Rate for Payer: EPIC Health Plan Senior |
$391.24
|
| Rate for Payer: Galaxy Health WC |
$831.38
|
| Rate for Payer: Global Benefits Group Commercial |
$586.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.67
|
| Rate for Payer: Multiplan Commercial |
$782.48
|
| Rate for Payer: Networks By Design Commercial |
$489.05
|
| Rate for Payer: Prime Health Services Commercial |
$831.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.08
|
| Rate for Payer: United Healthcare All Other HMO |
$357.30
|
| Rate for Payer: United Healthcare HMO Rider |
$349.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$831.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$831.38
|
| Rate for Payer: Vantage Medical Group Senior |
$831.38
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
915358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$368.90 |
| Rate for Payer: Adventist Health Commercial |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.37
|
| Rate for Payer: Blue Shield of California Commercial |
$320.29
|
| Rate for Payer: Blue Shield of California EPN |
$210.92
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$289.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.80
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$217.00
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.90
|
| Rate for Payer: Vantage Medical Group Senior |
$368.90
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
905358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$289.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$217.00
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
905358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$368.90 |
| Rate for Payer: Adventist Health Commercial |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.37
|
| Rate for Payer: Blue Shield of California Commercial |
$320.29
|
| Rate for Payer: Blue Shield of California EPN |
$210.92
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$289.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.80
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$217.00
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.90
|
| Rate for Payer: Vantage Medical Group Senior |
$368.90
|
|
|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
915358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$289.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.16
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Networks By Design Commercial |
$217.00
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
915358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.15
|
| Rate for Payer: Blue Shield of California Commercial |
$271.58
|
| Rate for Payer: Blue Shield of California EPN |
$178.85
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
915358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
905358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
905358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.15
|
| Rate for Payer: Blue Shield of California Commercial |
$271.58
|
| Rate for Payer: Blue Shield of California EPN |
$178.85
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC BREAST TOMO
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,419.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.33
|
| Rate for Payer: Blue Shield of California EPN |
$933.64
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC BREAST TOMO
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,419.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.33
|
| Rate for Payer: Blue Shield of California EPN |
$933.64
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$272.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.85
|
| Rate for Payer: Blue Shield of California Commercial |
$253.98
|
| Rate for Payer: Blue Shield of California EPN |
$167.66
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
