|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
OP
|
$6,284.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$373.98 |
| Max. Negotiated Rate |
$5,655.60 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$900.90
|
| 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 Exchange |
$1,074.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,493.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,958.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,494.75
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: Cigna of CA HMO |
$4,021.76
|
| Rate for Payer: Cigna of CA PPO |
$4,650.16
|
| 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 |
$4,398.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$5,341.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,770.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,655.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$373.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,990.34
|
| 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 |
$1,256.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,770.40
|
| 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
|
$5,503.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,100.60 |
| Max. Negotiated Rate |
$4,952.70 |
| Rate for Payer: Adventist Health Commercial |
$1,100.60
|
| Rate for Payer: Cash Price |
$2,476.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,402.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,852.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,201.20
|
| Rate for Payer: Galaxy Health WC |
$4,677.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,952.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,494.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,246.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.60
|
| Rate for Payer: Multiplan Commercial |
$4,127.25
|
| Rate for Payer: Networks By Design Commercial |
$3,576.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,677.55
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$5,503.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$4,952.70 |
| Rate for Payer: Adventist Health Commercial |
$1,100.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$481.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$691.37
|
| 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 Exchange |
$824.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,145.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,466.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,184.69
|
| Rate for Payer: Cash Price |
$2,476.35
|
| Rate for Payer: Cash Price |
$2,476.35
|
| Rate for Payer: Cash Price |
$2,476.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,402.40
|
| Rate for Payer: Cigna of CA HMO |
$3,521.92
|
| Rate for Payer: Cigna of CA PPO |
$4,072.22
|
| 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 |
$3,852.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$4,677.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,952.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$286.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,494.41
|
| 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 |
$1,100.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$4,127.25
|
| Rate for Payer: Networks By Design Commercial |
$3,576.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$481.58
|
| Rate for Payer: Prime Health Services Commercial |
$4,677.55
|
| Rate for Payer: Prime Health Services Medicare |
$510.47
|
| Rate for Payer: Riverside University Health System MISP |
$529.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,301.80
|
| 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 BRAF
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$207.60
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
|
|
HC BRAF
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$491.00
|
| Rate for Payer: Blue Shield of California Commercial |
$326.97
|
| Rate for Payer: Blue Shield of California Commercial |
$292.32
|
| Rate for Payer: Blue Shield of California EPN |
$206.04
|
| Rate for Payer: Blue Shield of California EPN |
$184.21
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$324.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.41
|
| Rate for Payer: EPIC Health Plan Senior |
$192.94
|
| Rate for Payer: EPIC Health Plan Senior |
$192.94
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.40
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Prime Health Services Medicare |
$185.92
|
| Rate for Payer: Prime Health Services Medicare |
$185.92
|
| Rate for Payer: Riverside University Health System MISP |
$192.94
|
| Rate for Payer: Riverside University Health System MISP |
$192.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.07
|
| Rate for Payer: United Healthcare All Other HMO |
$142.07
|
| Rate for Payer: United Healthcare All Other HMO |
$142.07
|
| Rate for Payer: United Healthcare HMO Rider |
$142.07
|
| Rate for Payer: United Healthcare HMO Rider |
$142.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAF PACKAGE
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$353.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$491.00
|
| Rate for Payer: Blue Shield of California Commercial |
$326.97
|
| Rate for Payer: Blue Shield of California Commercial |
$292.32
|
| Rate for Payer: Blue Shield of California EPN |
$206.04
|
| Rate for Payer: Blue Shield of California EPN |
$184.21
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$324.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.41
|
| Rate for Payer: EPIC Health Plan Senior |
$192.94
|
| Rate for Payer: EPIC Health Plan Senior |
$192.94
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$245.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.40
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Prime Health Services Medicare |
$185.92
|
| Rate for Payer: Prime Health Services Medicare |
$185.92
|
| Rate for Payer: Riverside University Health System MISP |
$192.94
|
| Rate for Payer: Riverside University Health System MISP |
$192.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.07
|
| Rate for Payer: United Healthcare All Other HMO |
$142.07
|
| Rate for Payer: United Healthcare All Other HMO |
$142.07
|
| Rate for Payer: United Healthcare HMO Rider |
$142.07
|
| Rate for Payer: United Healthcare HMO Rider |
$142.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAF PACKAGE
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$207.60
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$329.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$302.00 |
| Max. Negotiated Rate |
$1,359.00 |
| Rate for Payer: Adventist Health Commercial |
$302.00
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,208.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,057.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.00
|
| Rate for Payer: EPIC Health Plan Senior |
$604.00
|
| Rate for Payer: Galaxy Health WC |
$1,283.50
|
| Rate for Payer: Global Benefits Group Commercial |
$906.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,359.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$958.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$890.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.00
|
| Rate for Payer: Multiplan Commercial |
$1,132.50
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,283.50
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,510.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$230.69 |
| Max. Negotiated Rate |
$1,359.00 |
| Rate for Payer: Adventist Health Commercial |
$302.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,082.58
|
| 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 Exchange |
$699.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$878.37
|
| Rate for Payer: Blue Shield of California Commercial |
$951.30
|
| Rate for Payer: Blue Shield of California EPN |
$599.47
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,208.00
|
| Rate for Payer: Cigna of CA HMO |
$966.40
|
| Rate for Payer: Cigna of CA PPO |
$1,117.40
|
| 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 |
$1,057.00
|
| 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 |
$1,283.50
|
| Rate for Payer: Global Benefits Group Commercial |
$906.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$958.85
|
| 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 |
$302.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,132.50
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,283.50
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$906.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$906.00
|
| 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
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$273.79 |
| Max. Negotiated Rate |
$1,860.84 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,860.84
|
| 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 Exchange |
$797.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.81
|
| Rate for Payer: Blue Shield of California EPN |
$749.14
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Cigna of CA HMO |
$1,207.68
|
| Rate for Payer: Cigna of CA PPO |
$1,396.38
|
| 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 |
$1,320.90
|
| 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 |
$1,603.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,698.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,198.24
|
| 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 |
$377.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
| Rate for Payer: Networks By Design Commercial |
$1,226.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,603.95
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,132.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,132.20
|
| 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 IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$1,887.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,320.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$754.80
|
| Rate for Payer: EPIC Health Plan Senior |
$754.80
|
| Rate for Payer: Galaxy Health WC |
$1,603.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,698.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,198.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,113.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
| Rate for Payer: Networks By Design Commercial |
$1,226.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,603.95
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
IP
|
$3,961.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.20 |
| Max. Negotiated Rate |
$3,564.90 |
| Rate for Payer: Adventist Health Commercial |
$792.20
|
| Rate for Payer: Cash Price |
$1,782.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,168.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,772.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,584.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,584.40
|
| Rate for Payer: Galaxy Health WC |
$3,366.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,376.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,564.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,515.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,336.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.20
|
| Rate for Payer: Multiplan Commercial |
$2,970.75
|
| Rate for Payer: Networks By Design Commercial |
$2,574.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,366.85
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
OP
|
$3,961.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.20 |
| Max. Negotiated Rate |
$3,564.90 |
| Rate for Payer: Adventist Health Commercial |
$792.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,405.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,366.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,178.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,970.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,495.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,572.52
|
| Rate for Payer: Cash Price |
$1,782.45
|
| Rate for Payer: Cash Price |
$1,782.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,168.80
|
| Rate for Payer: Cigna of CA HMO |
$2,535.04
|
| Rate for Payer: Cigna of CA PPO |
$2,931.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,366.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,366.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,366.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,772.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,584.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,584.40
|
| Rate for Payer: Galaxy Health WC |
$3,366.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,376.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,564.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,515.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,437.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,336.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,772.70
|
| Rate for Payer: Multiplan Commercial |
$2,970.75
|
| Rate for Payer: Networks By Design Commercial |
$2,574.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,366.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,584.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,376.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,376.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,980.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,980.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,980.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,980.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,366.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,366.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,366.85
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$11,891.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,378.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,512.80
|
| Rate for Payer: Cigna of CA HMO |
$7,610.24
|
| Rate for Payer: Cigna of CA PPO |
$8,799.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,323.70
|
| 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 |
$10,107.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,701.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,550.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,918.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,729.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$10,107.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,945.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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 BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$11,891.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,701.90 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,512.80
|
| Rate for Payer: Cigna of CA HMO |
$7,610.24
|
| Rate for Payer: Cigna of CA PPO |
$8,799.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,323.70
|
| 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 |
$10,107.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,701.90
|
| 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 |
$7,550.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,918.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$7,729.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$10,107.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,945.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,945.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,945.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,945.50
|
| 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 BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$11,891.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,378.20 |
| Max. Negotiated Rate |
$10,701.90 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,512.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,323.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,756.40
|
| Rate for Payer: Galaxy Health WC |
$10,107.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,701.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,550.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,015.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$8,918.25
|
| Rate for Payer: Networks By Design Commercial |
$7,729.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,107.35
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$11,891.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,378.20 |
| Max. Negotiated Rate |
$10,701.90 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,512.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,323.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,756.40
|
| Rate for Payer: Galaxy Health WC |
$10,107.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,701.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,550.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,015.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$8,918.25
|
| Rate for Payer: Networks By Design Commercial |
$7,729.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,107.35
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$814.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Senior |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$686.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$640.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| Rate for Payer: Cigna of CA HMO |
$744.96
|
| Rate for Payer: Cigna of CA PPO |
$861.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$989.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$989.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$814.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Senior |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$686.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$814.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
| Rate for Payer: Riverside University Health System MISP |
$465.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.00
|
| 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 |
$989.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$989.40
|
| Rate for Payer: Vantage Medical Group Senior |
$989.40
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,196.80
|
| Rate for Payer: Cigna of CA PPO |
$1,383.80
|
| 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 |
$1,309.00
|
| 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 |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| 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 |
$1,187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.00
|
| 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
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$238.62 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$766.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.62
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,196.80
|
| Rate for Payer: Cigna of CA PPO |
$1,383.80
|
| 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 |
$1,309.00
|
| 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 |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| 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 |
$1,187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$979.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.00
|
| 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 CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,196.80
|
| Rate for Payer: Cigna of CA PPO |
$1,383.80
|
| 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 |
$1,309.00
|
| 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 |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| 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 |
$1,187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$935.00
|
| 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
|
IP
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,683.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| Rate for Payer: Networks By Design Commercial |
$1,215.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
|
