|
HC BRAF
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
|
|
HC BRAF PACKAGE
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
|
|
HC BRAF PACKAGE
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.79
|
| 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 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 HMO/PPO |
$71.68
|
| Rate for Payer: Blue Shield of California Commercial |
$281.65
|
| Rate for Payer: Blue Shield of California EPN |
$184.21
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.79
|
| Rate for Payer: EPIC Health Plan Senior |
$175.40
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| 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) Medicare Advantage |
$175.40
|
| Rate for Payer: InnovAge PACE Commercial |
$263.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.04
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.40
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Prime Health Services Medicare |
$185.92
|
| Rate for Payer: Riverside University Health System MISP |
$192.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| 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 HMO |
$142.07
|
| Rate for Payer: United Healthcare HMO Rider |
$142.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.07
|
| 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 Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
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 |
$830.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,208.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,007.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$934.69
|
| 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 |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$917.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$699.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$886.82
|
| Rate for Payer: Blue Shield of California Commercial |
$916.57
|
| Rate for Payer: Blue Shield of California EPN |
$599.47
|
| Rate for Payer: Cash Price |
$830.50
|
| Rate for Payer: Cash Price |
$830.50
|
| 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 |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| 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 |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| 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 |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,283.50
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| 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 |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
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 |
$1,037.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,509.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,258.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$718.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,168.05
|
| 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 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 |
$1,698.30 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,145.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$797.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,108.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.41
|
| Rate for Payer: Blue Shield of California EPN |
$749.14
|
| Rate for Payer: Cash Price |
$1,037.85
|
| Rate for Payer: Cash Price |
$1,037.85
|
| 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 |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| 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 |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,258.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| 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 |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,603.95
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| 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 |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
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 |
$1,917.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,404.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,572.52
|
| Rate for Payer: Cash Price |
$2,178.55
|
| 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: 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: InnovAge PACE Commercial |
$1,980.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,641.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,509.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,451.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,772.70
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$2,178.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,168.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,641.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,509.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,451.86
|
| 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 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 |
$6,540.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,512.80
|
| 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 Permanente of CA Commercial/Self Funded |
$7,931.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,530.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,360.53
|
| 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 |
$6,540.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,512.80
|
| 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 Permanente of CA Commercial/Self Funded |
$7,931.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,530.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,360.53
|
| 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
|
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 |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,865.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,540.05
|
| Rate for Payer: Cash Price |
$6,540.05
|
| Rate for Payer: Cash Price |
$6,540.05
|
| 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 |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| 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 |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,931.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| 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 |
$4,865.48
|
| 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 |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| 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 |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Cash Price |
$6,540.05
|
| Rate for Payer: Cash Price |
$6,540.05
|
| Rate for Payer: Cash Price |
$6,540.05
|
| Rate for Payer: Cash Price |
$6,540.05
|
| 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 |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| 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 |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,931.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| 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 |
$4,865.48
|
| 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 |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| 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 |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
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 |
$640.20
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| 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 Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.52
|
| 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 |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$563.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$683.62
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| 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: 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: InnovAge PACE Commercial |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$814.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
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 |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$905.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,098.25
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
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 |
$1,028.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| 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
|
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 |
$1,028.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| 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
|
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 |
$1,028.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,496.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| 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 |
$374.00 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,098.25
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
IP
|
$2,513.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$502.60 |
| Max. Negotiated Rate |
$2,261.70 |
| Rate for Payer: Adventist Health Commercial |
$502.60
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,005.20
|
| Rate for Payer: Galaxy Health WC |
$2,136.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,507.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,261.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$957.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,555.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.60
|
| Rate for Payer: Multiplan Commercial |
$1,884.75
|
| Rate for Payer: Networks By Design Commercial |
$1,633.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.05
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$2,513.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$204.27 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$502.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,216.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,525.39
|
| Rate for Payer: Blue Shield of California EPN |
$997.66
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,010.40
|
| Rate for Payer: Cigna of CA HMO |
$1,608.32
|
| Rate for Payer: Cigna of CA PPO |
$1,859.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,136.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,507.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,261.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,884.75
|
| Rate for Payer: Networks By Design Commercial |
$1,633.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.05
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,507.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,507.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,256.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,256.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,256.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,256.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$5,607.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,714.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,292.99
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,485.60
|
| Rate for Payer: Cigna of CA HMO |
$3,588.48
|
| Rate for Payer: Cigna of CA PPO |
$4,149.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$4,765.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,364.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,046.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$420.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,739.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,644.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$4,765.95
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,364.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
IP
|
$5,607.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,121.40 |
| Max. Negotiated Rate |
$5,046.30 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,485.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,242.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,242.80
|
| Rate for Payer: Galaxy Health WC |
$4,765.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,364.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,046.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,739.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,136.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,470.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.40
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
| Rate for Payer: Networks By Design Commercial |
$3,644.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,765.95
|
|
