|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,386.00
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,200.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,044.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
909177318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$481.58 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,385.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,069.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,210.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.77
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cigna of CA HMO |
$2,217.60
|
| Rate for Payer: Cigna of CA PPO |
$2,564.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,200.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,079.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
IP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,386.00
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,200.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,044.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN COMPLEX PRTN
|
Facility
|
OP
|
$3,465.00
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
904877318
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$481.58 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,385.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,069.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,210.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.77
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cash Price |
$1,559.25
|
| Rate for Payer: Cigna of CA HMO |
$2,217.60
|
| Rate for Payer: Cigna of CA PPO |
$2,564.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,200.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,079.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$365.28 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,020.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,524.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,021.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.73
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna of CA HMO |
$2,027.52
|
| Rate for Payer: Cigna of CA PPO |
$2,344.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$365.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,011.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$413.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,900.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,267.20
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,011.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,869.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$2,775.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.35 |
| Max. Negotiated Rate |
$2,358.75 |
| Rate for Payer: Adventist Health Commercial |
$555.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$783.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,169.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,770.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,168.28
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Cigna of CA HMO |
$1,776.00
|
| Rate for Payer: Cigna of CA PPO |
$2,053.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,942.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$2,358.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,762.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,803.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,358.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,665.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
IP
|
$2,775.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$2,358.75 |
| Rate for Payer: Adventist Health Commercial |
$555.00
|
| Rate for Payer: Cash Price |
$1,248.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,942.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,110.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,110.00
|
| Rate for Payer: Galaxy Health WC |
$2,358.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,665.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,762.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,637.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,803.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,358.75
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Adventist Health Commercial |
$334.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,170.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.80
|
| Rate for Payer: EPIC Health Plan Senior |
$668.80
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,061.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$986.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.28
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$225.32 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Adventist Health Commercial |
$334.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.92
|
| Rate for Payer: Blue Shield of California Commercial |
$703.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.74
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cigna of CA HMO |
$1,070.08
|
| Rate for Payer: Cigna of CA PPO |
$1,237.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,170.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,061.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,003.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,233.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$267.42 |
| Max. Negotiated Rate |
$2,108.46 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,108.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.79
|
| Rate for Payer: Blue Shield of California Commercial |
$880.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.06
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cigna of CA HMO |
$1,338.24
|
| Rate for Payer: Cigna of CA PPO |
$1,547.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
OP
|
$4,389.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$877.80 |
| Max. Negotiated Rate |
$3,730.65 |
| Rate for Payer: Adventist Health Commercial |
$877.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,878.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,730.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,413.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,291.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,816.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,847.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,800.18
|
| Rate for Payer: Cash Price |
$1,975.05
|
| Rate for Payer: Cigna of CA HMO |
$2,808.96
|
| Rate for Payer: Cigna of CA PPO |
$3,247.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,730.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,730.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,730.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,072.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,755.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,755.60
|
| Rate for Payer: Galaxy Health WC |
$3,730.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,633.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,787.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,593.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,589.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,072.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,072.30
|
| Rate for Payer: Multiplan Commercial |
$3,511.20
|
| Rate for Payer: Networks By Design Commercial |
$2,852.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,730.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,633.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,633.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,194.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,194.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,194.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,194.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,730.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,730.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3,730.65
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
IP
|
$4,389.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$877.80 |
| Max. Negotiated Rate |
$3,730.65 |
| Rate for Payer: Adventist Health Commercial |
$877.80
|
| Rate for Payer: Cash Price |
$1,975.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,072.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,755.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,755.60
|
| Rate for Payer: Galaxy Health WC |
$3,730.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,633.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,787.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,589.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.36
|
| Rate for Payer: Multiplan Commercial |
$3,511.20
|
| Rate for Payer: Networks By Design Commercial |
$2,852.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,730.65
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$8,788.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$7,469.80 |
| Rate for Payer: Adventist Health Commercial |
$1,757.60
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,151.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,515.20
|
| Rate for Payer: Galaxy Health WC |
$7,469.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,580.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,184.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,109.12
|
| Rate for Payer: Multiplan Commercial |
$7,030.40
|
| Rate for Payer: Networks By Design Commercial |
$5,712.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,469.80
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$8,788.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$8,309.24 |
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Adventist Health Commercial |
$1,757.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Cash Price |
$3,954.60
|
| Rate for Payer: Cigna of CA HMO |
$5,624.32
|
| Rate for Payer: Cigna of CA PPO |
$6,503.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,151.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$7,469.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,580.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,109.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,345.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$7,030.40
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$5,712.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,469.80
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,272.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,394.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,394.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,394.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,394.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$658.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$897.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cigna of CA HMO |
$766.08
|
| Rate for Payer: Cigna of CA PPO |
$885.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,017.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,017.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$837.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.80
|
| Rate for Payer: EPIC Health Plan Senior |
$478.80
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$760.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$706.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$837.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$837.90
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$598.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,017.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,017.45
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$837.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.80
|
| Rate for Payer: EPIC Health Plan Senior |
$478.80
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$760.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$706.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna of CA HMO |
$1,231.36
|
| Rate for Payer: Cigna of CA PPO |
$1,423.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$1,635.40 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Senior |
$769.60
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,135.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$1,635.40 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Senior |
$769.60
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,135.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$1,635.40 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Senior |
$769.60
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,135.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna of CA HMO |
$1,231.36
|
| Rate for Payer: Cigna of CA PPO |
$1,423.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$270.37 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$788.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna of CA HMO |
$1,231.36
|
| Rate for Payer: Cigna of CA PPO |
$1,423.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$199.52 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$871.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$807.71
|
| Rate for Payer: Blue Shield of California Commercial |
$532.99
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna of CA HMO |
$810.24
|
| Rate for Payer: Cigna of CA PPO |
$936.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$886.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
