|
HC BURR HOLES/ICP
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$278.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,044.75
|
| 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: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: Cigna of CA HMO |
$891.52
|
| Rate for Payer: Cigna of CA PPO |
$1,030.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,184.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$975.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Senior |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$507.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$884.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$821.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$975.10
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
| Rate for Payer: Riverside University Health System MISP |
$557.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$835.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$696.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.05
|
|
|
HC BURR HOLES/ICP
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Adventist Health Commercial |
$278.60
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$975.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Senior |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$884.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$821.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
|
|
HC BX BONE OPEN SUPERFICIAL
|
Facility
|
IP
|
$11,656.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
902320240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,331.20 |
| Max. Negotiated Rate |
$10,490.40 |
| Rate for Payer: Adventist Health Commercial |
$2,331.20
|
| Rate for Payer: Cash Price |
$5,245.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,324.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,662.40
|
| Rate for Payer: Galaxy Health WC |
$9,907.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,993.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,490.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,401.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,877.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,331.20
|
| Rate for Payer: Multiplan Commercial |
$8,742.00
|
| Rate for Payer: Networks By Design Commercial |
$7,576.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,907.60
|
|
|
HC BX BONE OPEN SUPERFICIAL
|
Facility
|
OP
|
$11,656.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
902320240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,331.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,735.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| 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 |
$5,794.14
|
| 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 |
$5,245.20
|
| Rate for Payer: Cash Price |
$5,245.20
|
| Rate for Payer: Cash Price |
$5,245.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,324.80
|
| Rate for Payer: Cigna of CA HMO |
$7,459.84
|
| Rate for Payer: Cigna of CA PPO |
$8,625.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4,109.55
|
| Rate for Payer: Galaxy Health WC |
$9,907.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,993.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,490.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,126.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,401.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,230.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,331.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$8,742.00
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$7,576.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Commercial |
$9,907.60
|
| Rate for Payer: Prime Health Services Medicare |
$3,960.11
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,109.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,993.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,828.00
|
| 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 |
$3,735.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$6,074.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,214.80 |
| Max. Negotiated Rate |
$5,466.60 |
| Rate for Payer: Adventist Health Commercial |
$1,214.80
|
| Rate for Payer: Cash Price |
$2,733.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,859.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,251.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,429.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,429.60
|
| Rate for Payer: Galaxy Health WC |
$5,162.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,466.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,856.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,583.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.80
|
| Rate for Payer: Multiplan Commercial |
$4,555.50
|
| Rate for Payer: Networks By Design Commercial |
$3,948.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,162.90
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$6,074.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$286.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,214.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$3,280.13
|
| 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 |
$2,733.30
|
| Rate for Payer: Cash Price |
$2,733.30
|
| Rate for Payer: Cash Price |
$2,733.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,859.20
|
| Rate for Payer: Cigna of CA HMO |
$3,887.36
|
| Rate for Payer: Cigna of CA PPO |
$4,494.76
|
| 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 |
$4,251.80
|
| 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 |
$5,162.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,644.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,466.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$286.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,856.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,555.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,948.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,162.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,644.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,037.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| 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
|
$5,327.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,065.40 |
| Max. Negotiated Rate |
$4,794.30 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,261.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,130.80
|
| Rate for Payer: Galaxy Health WC |
$4,527.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,794.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,382.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,142.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.40
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: Networks By Design Commercial |
$3,462.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.95
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$5,327.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,065.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$3,280.13
|
| 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 |
$2,397.15
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,261.60
|
| Rate for Payer: Cigna of CA HMO |
$3,409.28
|
| Rate for Payer: Cigna of CA PPO |
$3,941.98
|
| 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 |
$3,728.90
|
| 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 |
$4,527.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,794.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,087.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,382.64
|
| 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 |
$1,065.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,462.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.50
|
| 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 US IMAG
|
Facility
|
IP
|
$6,660.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,332.00 |
| Max. Negotiated Rate |
$5,994.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.00
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,662.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.00
|
| Rate for Payer: Galaxy Health WC |
$5,661.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,229.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.00
|
| Rate for Payer: Multiplan Commercial |
$4,995.00
|
| Rate for Payer: Networks By Design Commercial |
$4,329.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.00
|
|
|
HC BX BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$6,660.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,055.94 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$3,280.13
|
| 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 |
$2,997.00
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.00
|
| Rate for Payer: Cigna of CA HMO |
$4,262.40
|
| Rate for Payer: Cigna of CA PPO |
$4,928.40
|
| 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 |
$4,662.00
|
| 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 |
$5,661.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,055.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,229.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,166.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,995.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,329.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.00
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,330.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| 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 ADD LESION MR IMAG
|
Facility
|
OP
|
$6,392.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,278.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,515.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,794.00
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,113.60
|
| Rate for Payer: Cigna of CA HMO |
$4,090.88
|
| Rate for Payer: Cigna of CA PPO |
$4,730.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,433.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,433.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,474.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,556.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,556.80
|
| Rate for Payer: Galaxy Health WC |
$5,433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,752.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,058.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,771.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,278.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,474.40
|
| Rate for Payer: Multiplan Commercial |
$4,794.00
|
| Rate for Payer: Networks By Design Commercial |
$4,154.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,433.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,196.00
|
| 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 |
$5,433.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,433.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,433.20
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$6,392.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,278.40 |
| Max. Negotiated Rate |
$5,752.80 |
| Rate for Payer: Adventist Health Commercial |
$1,278.40
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,113.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,474.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,556.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,556.80
|
| Rate for Payer: Galaxy Health WC |
$5,433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,752.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,058.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,771.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,278.40
|
| Rate for Payer: Multiplan Commercial |
$4,794.00
|
| Rate for Payer: Networks By Design Commercial |
$4,154.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,433.20
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$5,327.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,065.40 |
| Max. Negotiated Rate |
$4,794.30 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,261.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,130.80
|
| Rate for Payer: Galaxy Health WC |
$4,527.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,794.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,382.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,142.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.40
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: Networks By Design Commercial |
$3,462.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.95
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$5,327.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.10 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,929.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,995.25
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,261.60
|
| Rate for Payer: Cigna of CA HMO |
$3,409.28
|
| Rate for Payer: Cigna of CA PPO |
$3,941.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,527.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,527.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,130.80
|
| Rate for Payer: Galaxy Health WC |
$4,527.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,794.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$906.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,382.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,000.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,142.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,728.90
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: Networks By Design Commercial |
$3,462.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.50
|
| 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 |
$4,527.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,527.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,527.95
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$6,660.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,332.00 |
| Max. Negotiated Rate |
$5,994.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.00
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,662.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.00
|
| Rate for Payer: Galaxy Health WC |
$5,661.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,229.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.00
|
| Rate for Payer: Multiplan Commercial |
$4,995.00
|
| Rate for Payer: Networks By Design Commercial |
$4,329.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.00
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$6,660.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.19 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$446.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.00
|
| 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: Blue Shield of California Commercial |
$4,195.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,644.02
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Cash Price |
$2,997.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.00
|
| Rate for Payer: Cigna of CA HMO |
$4,262.40
|
| Rate for Payer: Cigna of CA PPO |
$4,928.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,662.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.00
|
| Rate for Payer: Galaxy Health WC |
$5,661.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$871.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,229.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$962.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,662.00
|
| Rate for Payer: Multiplan Commercial |
$4,995.00
|
| Rate for Payer: Networks By Design Commercial |
$4,329.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,664.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,330.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,330.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,330.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,330.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.00
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$3,771.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$754.20 |
| Max. Negotiated Rate |
$3,393.90 |
| Rate for Payer: Adventist Health Commercial |
$754.20
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,639.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.40
|
| Rate for Payer: Galaxy Health WC |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,394.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,224.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$3,771.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$754.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 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 |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO |
$2,413.44
|
| Rate for Payer: Cigna of CA PPO |
$2,790.54
|
| 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 |
$2,639.70
|
| 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 |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,394.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,262.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,885.50
|
| 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 PERCUT W/O IMAGE
|
Facility
|
IP
|
$3,771.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$754.20 |
| Max. Negotiated Rate |
$3,393.90 |
| Rate for Payer: Adventist Health Commercial |
$754.20
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,639.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.40
|
| Rate for Payer: Galaxy Health WC |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,394.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,224.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$3,771.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$754.20
|
| 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 |
$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 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 |
$3,280.13
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO |
$2,413.44
|
| Rate for Payer: Cigna of CA PPO |
$2,790.54
|
| 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 |
$2,639.70
|
| 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 |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| 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 |
$2,394.59
|
| 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 |
$754.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,262.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,885.50
|
| 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
|
$3,771.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,546.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.36
|
| 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 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 |
$3,280.13
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO |
$2,413.44
|
| Rate for Payer: Cigna of CA PPO |
$2,790.54
|
| 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 |
$2,639.70
|
| 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 |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| 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 |
$2,394.59
|
| 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 |
$754.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,262.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,262.60
|
| 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
|
IP
|
$3,771.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$754.20 |
| Max. Negotiated Rate |
$3,393.90 |
| Rate for Payer: Adventist Health Commercial |
$754.20
|
| Rate for Payer: Cash Price |
$1,696.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,016.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,639.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.40
|
| Rate for Payer: Galaxy Health WC |
$3,205.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,393.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,394.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,224.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$2,828.25
|
| Rate for Payer: Networks By Design Commercial |
$2,451.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,205.35
|
|
|
HC BX OF LACRIMAL GLAND
|
Facility
|
IP
|
$9,219.00
|
|
|
Service Code
|
CPT 68510
|
| Hospital Charge Code |
988168510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,843.80 |
| Max. Negotiated Rate |
$8,297.10 |
| Rate for Payer: Adventist Health Commercial |
$1,843.80
|
| Rate for Payer: Cash Price |
$4,148.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,375.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,453.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,687.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,687.60
|
| Rate for Payer: Galaxy Health WC |
$7,836.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,531.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,297.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,854.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,439.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,843.80
|
| Rate for Payer: Multiplan Commercial |
$6,914.25
|
| Rate for Payer: Networks By Design Commercial |
$5,992.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,836.15
|
|
|
HC BX OF LACRIMAL GLAND
|
Facility
|
OP
|
$9,219.00
|
|
|
Service Code
|
CPT 68510
|
| Hospital Charge Code |
988168510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$819.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,843.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| 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 |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,148.55
|
| Rate for Payer: Cash Price |
$4,148.55
|
| Rate for Payer: Cash Price |
$4,148.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,375.20
|
| Rate for Payer: Cigna of CA HMO |
$5,900.16
|
| Rate for Payer: Cigna of CA PPO |
$6,822.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,453.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$7,836.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,531.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,297.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$819.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,854.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$904.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,843.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$6,914.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$5,992.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,836.15
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,531.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,609.50
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC BX OF PLEURA PERC NEEDLE
|
Facility
|
IP
|
$6,395.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
900831706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,279.00 |
| Max. Negotiated Rate |
$5,755.50 |
| Rate for Payer: Adventist Health Commercial |
$1,279.00
|
| Rate for Payer: Cash Price |
$2,877.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,116.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,476.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,558.00
|
| Rate for Payer: Galaxy Health WC |
$5,435.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,755.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,060.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,773.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,279.00
|
| Rate for Payer: Multiplan Commercial |
$4,796.25
|
| Rate for Payer: Networks By Design Commercial |
$4,156.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,435.75
|
|
