|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$36.71 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.71
|
| Rate for Payer: Blue Shield of California Commercial |
$9.37
|
| Rate for Payer: Blue Shield of California EPN |
$6.19
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
IP
|
$44.94
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Adventist Health Commercial |
$8.99
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Senior |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$38.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$35.95
|
| Rate for Payer: Networks By Design Commercial |
$29.21
|
| Rate for Payer: Prime Health Services Commercial |
$38.20
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
OP
|
$44.94
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Adventist Health Commercial |
$8.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cigna of CA HMO |
$28.76
|
| Rate for Payer: Cigna of CA PPO |
$33.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Senior |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$38.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.46
|
| Rate for Payer: Multiplan Commercial |
$35.95
|
| Rate for Payer: Networks By Design Commercial |
$29.21
|
| Rate for Payer: Prime Health Services Commercial |
$38.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.47
|
| Rate for Payer: United Healthcare All Other HMO |
$22.47
|
| Rate for Payer: United Healthcare HMO Rider |
$22.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.20
|
| Rate for Payer: Vantage Medical Group Senior |
$38.20
|
|
|
HC BUN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$38.97 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Senior |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$38.97 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$25.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.80
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Senior |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BURR HOLES/ICP
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC BURR HOLES/ICP
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$3,063.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.60 |
| Max. Negotiated Rate |
$2,603.55 |
| Rate for Payer: Adventist Health Commercial |
$612.60
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,225.20
|
| Rate for Payer: Galaxy Health WC |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,043.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,896.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.12
|
| Rate for Payer: Multiplan Commercial |
$2,450.40
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.59 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$612.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cigna of CA HMO |
$1,960.32
|
| Rate for Payer: Cigna of CA PPO |
$2,266.62
|
| 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 |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,043.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.12
|
| 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 |
$2,450.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,837.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| 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 BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$2,283.95 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.80
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,023.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,663.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cigna of CA HMO |
$1,719.68
|
| Rate for Payer: Cigna of CA PPO |
$1,988.38
|
| 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 |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,062.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| 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 |
$2,149.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,612.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| 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 BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$3,224.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$644.80 |
| Max. Negotiated Rate |
$2,740.40 |
| Rate for Payer: Adventist Health Commercial |
$644.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,289.60
|
| Rate for Payer: Galaxy Health WC |
$2,740.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,934.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,150.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,228.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,995.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.76
|
| Rate for Payer: Multiplan Commercial |
$2,579.20
|
| Rate for Payer: Networks By Design Commercial |
$2,095.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,740.40
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$3,224.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.10 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$644.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,740.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,418.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna of CA HMO |
$2,063.36
|
| Rate for Payer: Cigna of CA PPO |
$2,385.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,740.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,740.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,740.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,289.60
|
| Rate for Payer: Galaxy Health WC |
$2,740.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,934.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,150.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,995.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,256.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,256.80
|
| Rate for Payer: Multiplan Commercial |
$2,579.20
|
| Rate for Payer: Networks By Design Commercial |
$2,095.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,740.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,934.40
|
| 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 |
$2,740.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,740.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,740.40
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,283.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,477.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,015.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cigna of CA HMO |
$1,719.68
|
| Rate for Payer: Cigna of CA PPO |
$1,988.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,283.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,283.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,283.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.80
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$885.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,663.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,880.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,880.90
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,612.20
|
| 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 |
$2,283.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,283.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,283.95
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$2,283.95 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.80
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,023.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,663.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$3,359.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$671.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$671.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,855.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,847.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,519.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,055.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.04
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cigna of CA HMO |
$2,149.76
|
| Rate for Payer: Cigna of CA PPO |
$2,485.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,855.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,855.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,855.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.60
|
| Rate for Payer: Galaxy Health WC |
$2,855.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,015.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$851.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,240.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$962.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,079.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,351.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,351.30
|
| Rate for Payer: Multiplan Commercial |
$2,687.20
|
| Rate for Payer: Networks By Design Commercial |
$2,183.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,855.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,015.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,015.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,679.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,679.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,679.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,855.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,855.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,855.15
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$3,359.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$671.80 |
| Max. Negotiated Rate |
$2,855.15 |
| Rate for Payer: Adventist Health Commercial |
$671.80
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.60
|
| Rate for Payer: Galaxy Health WC |
$2,855.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,015.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,240.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,279.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,079.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.16
|
| Rate for Payer: Multiplan Commercial |
$2,687.20
|
| Rate for Payer: Networks By Design Commercial |
$2,183.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,855.15
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cigna of CA HMO |
$1,783.04
|
| Rate for Payer: Cigna of CA PPO |
$2,061.64
|
| 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 |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.64
|
| 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 |
$2,228.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,671.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,393.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,393.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,393.00
|
| 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 BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$2,368.10 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.40
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,858.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,724.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.64
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,771.85 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.40
|
| Rate for Payer: Galaxy Health WC |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,175.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,242.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,018.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.64
|
| Rate for Payer: Multiplan Commercial |
$2,608.80
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| 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 |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cigna of CA HMO |
$2,087.04
|
| Rate for Payer: Cigna of CA PPO |
$2,413.14
|
| 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 |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| 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 |
$2,175.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.64
|
| 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 |
$2,608.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,630.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,630.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,630.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.50
|
| 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 C-14 UREA BREATH TEST ACQ
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.10
|
| Rate for Payer: Blue Shield of California Commercial |
$317.02
|
| Rate for Payer: Blue Shield of California EPN |
$209.27
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.93
|
| Rate for Payer: EPIC Health Plan Senior |
$11.06
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.51
|
| Rate for Payer: United Healthcare All Other HMO |
$28.51
|
| Rate for Payer: United Healthcare HMO Rider |
$28.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
