|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$3,063.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.60 |
| Max. Negotiated Rate |
$2,603.55 |
| Rate for Payer: Adventist Health Commercial |
$612.60
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,225.20
|
| Rate for Payer: Galaxy Health WC |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,945.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,807.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.12
|
| Rate for Payer: Multiplan Commercial |
$2,450.40
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cigna of CA HMO |
$1,719.68
|
| Rate for Payer: Cigna of CA PPO |
$1,988.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,880.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,062.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,706.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,201.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,612.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,343.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$2,283.95 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,880.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.80
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,706.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,585.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$3,224.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$644.80 |
| Max. Negotiated Rate |
$2,740.40 |
| Rate for Payer: EPIC Health Plan Senior |
$1,289.60
|
| Rate for Payer: Galaxy Health WC |
$2,740.40
|
| Rate for Payer: Adventist Health Commercial |
$644.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,256.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,289.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,934.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,047.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,902.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.76
|
| Rate for Payer: Multiplan Commercial |
$2,579.20
|
| Rate for Payer: Networks By Design Commercial |
$2,095.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,740.40
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$3,224.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.10 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$644.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,740.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,773.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,418.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna of CA HMO |
$2,063.36
|
| Rate for Payer: Cigna of CA PPO |
$2,385.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,740.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,740.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,740.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,256.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,289.60
|
| Rate for Payer: Galaxy Health WC |
$2,740.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,934.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,047.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,902.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,256.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,256.80
|
| Rate for Payer: Multiplan Commercial |
$2,579.20
|
| Rate for Payer: Networks By Design Commercial |
$2,095.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,740.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,612.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,740.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,740.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,740.40
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$2,283.95 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,880.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.80
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,706.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,585.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$537.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,283.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,477.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,015.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cash Price |
$1,209.15
|
| Rate for Payer: Cigna of CA HMO |
$1,719.68
|
| Rate for Payer: Cigna of CA PPO |
$1,988.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,283.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,283.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,283.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,880.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,074.80
|
| Rate for Payer: Galaxy Health WC |
$2,283.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,612.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$885.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,706.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,000.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,585.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,880.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,880.90
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: Networks By Design Commercial |
$1,746.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,283.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,612.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,343.50
|
| 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 |
$2,283.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,283.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,283.95
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$3,359.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$671.80 |
| Max. Negotiated Rate |
$2,855.15 |
| Rate for Payer: Adventist Health Commercial |
$671.80
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,351.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.60
|
| Rate for Payer: Galaxy Health WC |
$2,855.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,015.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,132.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,981.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.16
|
| Rate for Payer: Multiplan Commercial |
$2,687.20
|
| Rate for Payer: Networks By Design Commercial |
$2,183.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,855.15
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$3,359.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$505.56 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$671.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,855.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,847.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,519.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,143.04
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cigna of CA HMO |
$2,149.76
|
| Rate for Payer: Cigna of CA PPO |
$2,485.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,855.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,855.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,855.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,351.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.60
|
| Rate for Payer: Galaxy Health WC |
$2,855.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,015.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$851.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,132.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$962.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,981.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,351.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,351.30
|
| Rate for Payer: Multiplan Commercial |
$2,687.20
|
| Rate for Payer: Networks By Design Commercial |
$2,183.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,855.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,015.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,015.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,679.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,679.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,679.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,855.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,855.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,855.15
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,142.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cigna of CA HMO |
$1,783.04
|
| Rate for Payer: Cigna of CA PPO |
$2,061.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,671.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,671.60
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Cigna of CA HMO |
$1,783.04
|
| Rate for Payer: Cigna of CA PPO |
$2,061.64
|
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,671.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,393.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,393.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,393.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$2,368.10 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.40
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.64
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$2,368.10 |
| Rate for Payer: Adventist Health Commercial |
$557.20
|
| Rate for Payer: Cash Price |
$1,253.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,950.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.40
|
| Rate for Payer: Galaxy Health WC |
$2,368.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,769.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.64
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Networks By Design Commercial |
$1,810.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.10
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,771.85 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.40
|
| Rate for Payer: Galaxy Health WC |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,923.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.64
|
| Rate for Payer: Multiplan Commercial |
$2,608.80
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| 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 |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cigna of CA HMO |
$2,087.04
|
| Rate for Payer: Cigna of CA PPO |
$2,413.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| 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 |
$2,282.70
|
| 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 |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| 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 |
$2,070.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.64
|
| 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 |
$2,608.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,630.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,630.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,630.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 C-14 UREA BREATH TEST ACQ
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.40
|
| Rate for Payer: Blue Shield of California Commercial |
$330.48
|
| Rate for Payer: Blue Shield of California Commercial |
$218.08
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$12.17
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.51
|
| Rate for Payer: United Healthcare All Other HMO |
$28.51
|
| Rate for Payer: United Healthcare HMO Rider |
$28.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$94.41 |
| Max. Negotiated Rate |
$683.40 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.78
|
| Rate for Payer: Blue Shield of California Commercial |
$320.91
|
| Rate for Payer: Blue Shield of California Commercial |
$211.76
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.78
|
| Rate for Payer: EPIC Health Plan Senior |
$103.85
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$154.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.51
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.22
|
| Rate for Payer: United Healthcare All Other HMO |
$244.22
|
| Rate for Payer: United Healthcare HMO Rider |
$244.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$94.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Vantage Medical Group Senior |
$94.41
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC CABLE MED COAXIAL UMBILICAL
|
Facility
|
OP
|
$644.00
|
|
| Hospital Charge Code |
906812449
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.25
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$547.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$322.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC CABLE MED COAXIAL UMBILICAL
|
Facility
|
IP
|
$644.00
|
|
| Hospital Charge Code |
906812449
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
|
|
HC CABLE MED ELECTRICAL UMBILICAL
|
Facility
|
IP
|
$966.00
|
|
| Hospital Charge Code |
906812448
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$821.10 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$676.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Senior |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$613.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$569.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.84
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
|
|
HC CABLE MED ELECTRICAL UMBILICAL
|
Facility
|
OP
|
$966.00
|
|
| Hospital Charge Code |
906812448
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$821.10 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$633.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$821.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$531.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$724.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$619.88
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cigna of CA HMO |
$618.24
|
| Rate for Payer: Cigna of CA PPO |
$714.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$821.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$821.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$821.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$676.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Senior |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$613.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$569.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$676.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$676.20
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$579.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$579.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other HMO |
$483.00
|
| Rate for Payer: United Healthcare HMO Rider |
$483.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$821.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$821.10
|
| Rate for Payer: Vantage Medical Group Senior |
$821.10
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$223.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$141.06 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$174.26
|
| Rate for Payer: Blue Shield of California Commercial |
$46.10
|
| Rate for Payer: Blue Shield of California Commercial |
$263.47
|
| Rate for Payer: Blue Shield of California Commercial |
$69.70
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
