|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
OP
|
$12,082.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$713.03 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,249.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$5,436.90
|
| Rate for Payer: Cash Price |
$5,436.90
|
| Rate for Payer: Cigna of CA PPO |
$8,940.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Galaxy Health WC |
$10,269.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,249.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,024.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,024.46
|
| Rate for Payer: IEHP Medi-Cal |
$13,853.43
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,058.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$713.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,899.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan Commercial |
$9,665.60
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Networks By Design Commercial |
$7,853.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,269.70
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,249.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,249.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
IP
|
$12,082.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.68 |
| Max. Negotiated Rate |
$10,269.70 |
| Rate for Payer: Cash Price |
$5,436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,832.80
|
| Rate for Payer: Galaxy Health WC |
$10,269.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,249.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,058.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,603.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,899.68
|
| Rate for Payer: Multiplan Commercial |
$9,665.60
|
| Rate for Payer: Networks By Design Commercial |
$7,853.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,269.70
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
IP
|
$9,302.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,232.48 |
| Max. Negotiated Rate |
$7,906.70 |
| Rate for Payer: Cash Price |
$4,185.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,720.80
|
| Rate for Payer: Galaxy Health WC |
$7,906.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,581.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,204.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,544.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,232.48
|
| Rate for Payer: Multiplan Commercial |
$7,441.60
|
| Rate for Payer: Networks By Design Commercial |
$6,046.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,906.70
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
OP
|
$9,302.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$7,906.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,581.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,855.57
|
| Rate for Payer: Blue Shield of California EPN |
$5,432.37
|
| Rate for Payer: Cash Price |
$4,185.90
|
| Rate for Payer: Cash Price |
$4,185.90
|
| Rate for Payer: Cigna of CA HMO |
$5,953.28
|
| Rate for Payer: Cigna of CA PPO |
$6,883.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$7,906.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,581.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,976.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: IEHP Medi-Cal |
$7,579.87
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,204.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,232.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$7,441.60
|
| Rate for Payer: Networks By Design Commercial |
$6,046.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,906.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,581.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,581.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,581.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,651.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,651.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,651.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,651.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC BUFFY COAT EXAM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$33.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.91
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.60
|
| Rate for Payer: Dignity Health Media |
$5.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.07
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.31
|
| Rate for Payer: IEHP Medi-Cal |
$8.21
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$8.21
|
| Rate for Payer: IEHP Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| 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 |
$3.60
|
| 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 |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| 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: Vantage Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUN
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$35.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.99
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Media |
$3.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$6.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6.40
|
| Rate for Payer: IEHP Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| 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 |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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: 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 BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$35.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.99
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Media |
$3.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$6.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6.40
|
| Rate for Payer: IEHP Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| 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 |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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: 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
OP
|
$870.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,625.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$478.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$522.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna of CA PPO |
$643.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Media |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$652.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC BURR HOLES/ICP
|
Facility
IP
|
$870.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$910.56 |
| Max. Negotiated Rate |
$3,224.90 |
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,517.60
|
| Rate for Payer: Galaxy Health WC |
$3,224.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,276.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,445.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.56
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Networks By Design Commercial |
$2,466.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,224.90
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
OP
|
$3,794.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.20 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,276.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: Cigna of CA PPO |
$2,807.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,224.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,276.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,845.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: IEHP Medi-Cal |
$3,281.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Networks By Design Commercial |
$2,466.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,224.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,276.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,276.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
IP
|
$3,328.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$2,828.80 |
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
OP
|
$3,328.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,996.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$2,462.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: IEHP Medi-Cal |
$3,281.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,996.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,996.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
IP
|
$3,993.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$958.32 |
| Max. Negotiated Rate |
$3,394.05 |
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,597.20
|
| Rate for Payer: Galaxy Health WC |
$3,394.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,395.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,663.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,521.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.32
|
| Rate for Payer: Multiplan Commercial |
$3,194.40
|
| Rate for Payer: Networks By Design Commercial |
$2,595.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,394.05
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
OP
|
$3,993.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,394.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,196.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,196.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,395.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: Cash Price |
$1,796.85
|
| Rate for Payer: Cigna of CA PPO |
$2,954.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,394.05
|
| Rate for Payer: Dignity Health Media |
$3,394.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,394.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,597.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,597.20
|
| Rate for Payer: Galaxy Health WC |
$3,394.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,395.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,994.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,663.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.32
|
| Rate for Payer: Multiplan Commercial |
$3,194.40
|
| Rate for Payer: Networks By Design Commercial |
$2,595.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,394.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,395.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,395.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,394.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,394.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,394.05
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
OP
|
$3,328.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,828.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,830.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,830.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,996.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cigna of CA PPO |
$2,462.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,828.80
|
| Rate for Payer: Dignity Health Media |
$2,828.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,496.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,996.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,996.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,828.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,828.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,828.80
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
IP
|
$3,328.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$2,828.80 |
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,828.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,996.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,219.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: Networks By Design Commercial |
$2,163.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,828.80
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
OP
|
$4,160.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$962.73 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,536.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,288.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,288.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,458.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,951.04
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$2,662.40
|
| Rate for Payer: Cigna of CA PPO |
$3,078.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,536.00
|
| Rate for Payer: Dignity Health Media |
$3,536.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,536.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,664.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,664.00
|
| Rate for Payer: Galaxy Health WC |
$3,536.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,496.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,774.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$962.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$3,328.00
|
| Rate for Payer: Networks By Design Commercial |
$2,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,536.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,496.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,496.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,080.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,080.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,080.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,080.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,536.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,536.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,536.00
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
IP
|
$4,160.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,664.00
|
| Rate for Payer: Galaxy Health WC |
$3,536.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,496.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,774.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$3,328.00
|
| Rate for Payer: Networks By Design Commercial |
$2,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,536.00
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,710.60
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cigna of CA PPO |
$2,109.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,138.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$2,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,710.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,710.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$684.24 |
| Max. Negotiated Rate |
$2,423.35 |
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.40
|
| Rate for Payer: Galaxy Health WC |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.24
|
| Rate for Payer: Multiplan Commercial |
$2,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
IP
|
$3,337.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$800.88 |
| Max. Negotiated Rate |
$2,836.45 |
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.80
|
| Rate for Payer: Galaxy Health WC |
$2,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,002.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,225.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.88
|
| Rate for Payer: Multiplan Commercial |
$2,669.60
|
| Rate for Payer: Networks By Design Commercial |
$2,169.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,836.45
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
OP
|
$3,337.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,002.20
|
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: Cash Price |
$1,501.65
|
| Rate for Payer: Cigna of CA PPO |
$2,469.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,002.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,502.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,225.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,669.60
|
| Rate for Payer: Networks By Design Commercial |
$2,169.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,836.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,002.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,668.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,668.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,668.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,668.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
IP
|
$610.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
OP
|
$610.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.44
|
| Rate for Payer: BCBS Transplant Transplant |
$366.00
|
| Rate for Payer: Blue Shield of California Commercial |
$360.51
|
| Rate for Payer: Blue Shield of California EPN |
$286.09
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Media |
$11.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.06
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$457.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.14
|
| Rate for Payer: IEHP Medi-Cal |
$17.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$17.92
|
| Rate for Payer: IEHP Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.51
|
| Rate for Payer: United Healthcare All Other HMO |
$28.51
|
| Rate for Payer: United Healthcare HMO Rider |
$28.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
