|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$950.20 |
| Max. Negotiated Rate |
$4,275.90 |
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.40
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
909177317
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$413.14 |
| Max. Negotiated Rate |
$4,275.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$838.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,074.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,310.64
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,936.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,308.99
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: Cigna of CA HMO |
$3,040.64
|
| Rate for Payer: Cigna of CA PPO |
$3,515.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,563.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$761.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: InnovAge PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Riverside University Health System MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,850.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$4,161.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$3,744.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$643.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$824.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,005.24
|
| Rate for Payer: Blue Distinction Transplant |
$2,496.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,571.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,022.25
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$1,872.45
|
| Rate for Payer: Cash Price |
$1,872.45
|
| Rate for Payer: Cash Price |
$1,872.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,328.80
|
| Rate for Payer: Cigna of CA HMO |
$2,663.04
|
| Rate for Payer: Cigna of CA PPO |
$3,079.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,536.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,744.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,120.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$761.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: InnovAge PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,775.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$832.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,120.75
|
| Rate for Payer: Networks By Design Commercial |
$2,704.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,536.85
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Riverside University Health System MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC BRACHYTHERAPY ISODOSE PLAN SIMPLE
|
Facility
|
IP
|
$4,161.00
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
909177316
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$832.20 |
| Max. Negotiated Rate |
$3,744.90 |
| Rate for Payer: Cash Price |
$1,872.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,328.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,664.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,664.40
|
| Rate for Payer: Galaxy Health WC |
$3,536.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,744.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,775.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,585.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$832.20
|
| Rate for Payer: Multiplan Commercial |
$3,120.75
|
| Rate for Payer: Networks By Design Commercial |
$2,704.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,536.85
|
|
|
HC BRAF
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$430.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group 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 |
$430.79
|
| Rate for Payer: Blue Distinction Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$124.84
|
| Rate for Payer: Blue Shield of California EPN |
$98.17
|
| Rate for Payer: Caremore Medicare Advantage |
$175.40
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$129.28
|
| Rate for Payer: Cigna of CA PPO |
$149.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Media |
$175.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$175.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.40
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.41
|
| 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 |
$134.73
|
| 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 |
$40.40
|
| 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 |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$131.30
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| 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 |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| 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: 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 BRAF
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Central Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: Galaxy Health WC |
$240.55
|
| Rate for Payer: Global Benefits Group Commercial |
$169.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.60
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
| Rate for Payer: Networks By Design Commercial |
$183.95
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
|
|
HC BRAF PACKAGE
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$430.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$175.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group 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 |
$430.79
|
| Rate for Payer: Blue Distinction Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$124.84
|
| Rate for Payer: Blue Shield of California EPN |
$98.17
|
| Rate for Payer: Caremore Medicare Advantage |
$175.40
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$129.28
|
| Rate for Payer: Cigna of CA PPO |
$149.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Media |
$175.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$175.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.40
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$287.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.41
|
| 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 |
$134.73
|
| 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 |
$40.40
|
| 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 |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$131.30
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| 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 |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| 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: 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 BRAF PACKAGE
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$254.70 |
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Central Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: Galaxy Health WC |
$240.55
|
| Rate for Payer: Global Benefits Group Commercial |
$169.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$254.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.60
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
| Rate for Payer: Networks By Design Commercial |
$183.95
|
| Rate for Payer: Prime Health Services Commercial |
$240.55
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$254.83 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$956.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$699.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,104.21
|
| Rate for Payer: Blue Distinction Transplant |
$1,121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,155.04
|
| Rate for Payer: Blue Shield of California EPN |
$908.33
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,383.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,401.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,114.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Riverside University Health System MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$2,337.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$467.40 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Cash Price |
$1,051.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,869.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$934.80
|
| Rate for Payer: Galaxy Health WC |
$1,986.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,402.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,103.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,558.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.40
|
| Rate for Payer: Multiplan Commercial |
$1,752.75
|
| Rate for Payer: Networks By Design Commercial |
$1,519.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,986.45
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
OP
|
$2,337.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$302.44 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,643.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$797.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,380.70
|
| Rate for Payer: Blue Distinction Transplant |
$1,402.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,444.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,135.78
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,051.65
|
| Rate for Payer: Cash Price |
$1,051.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,869.60
|
| Rate for Payer: Cigna of CA HMO |
$1,495.68
|
| Rate for Payer: Cigna of CA PPO |
$1,729.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$1,986.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,402.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,103.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,752.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,114.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,558.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$1,752.75
|
| Rate for Payer: Networks By Design Commercial |
$1,519.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,986.45
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Riverside University Health System MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,402.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,402.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$8,991.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,798.20 |
| Max. Negotiated Rate |
$8,091.90 |
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,192.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.40
|
| Rate for Payer: Galaxy Health WC |
$7,642.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,091.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,997.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,425.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.20
|
| Rate for Payer: Multiplan Commercial |
$6,743.25
|
| Rate for Payer: Networks By Design Commercial |
$5,844.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,642.35
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$8,991.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,798.20 |
| Max. Negotiated Rate |
$8,091.90 |
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,192.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,596.40
|
| Rate for Payer: Galaxy Health WC |
$7,642.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,091.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,997.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,425.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.20
|
| Rate for Payer: Multiplan Commercial |
$6,743.25
|
| Rate for Payer: Networks By Design Commercial |
$5,844.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,642.35
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$8,991.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,798.20 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,762.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,394.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,192.80
|
| Rate for Payer: Cigna of CA PPO |
$6,653.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$7,642.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,091.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,743.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,858.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,997.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$6,743.25
|
| Rate for Payer: Networks By Design Commercial |
$5,844.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,642.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,394.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$8,991.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,091.90 |
| 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 |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,394.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Cash Price |
$4,045.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,192.80
|
| Rate for Payer: Cigna of CA PPO |
$6,653.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$7,642.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,394.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,091.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,743.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,997.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$6,743.25
|
| Rate for Payer: Networks By Design Commercial |
$5,844.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,642.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,394.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,495.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,495.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,495.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,495.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$639.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA PPO |
$788.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.25
|
| Rate for Payer: Dignity Health Media |
$905.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$798.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$372.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Riverside University Health System MISP |
$426.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.25
|
| Rate for Payer: Vantage Medical Group Senior |
$905.25
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,027.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,369.60
|
| Rate for Payer: Cigna of CA PPO |
$1,266.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,455.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,027.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,540.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,284.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,284.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,455.20
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$1,540.80 |
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,369.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.80
|
| Rate for Payer: Galaxy Health WC |
$1,455.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,027.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,540.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.40
|
| Rate for Payer: Multiplan Commercial |
$1,284.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,455.20
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,027.20
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,369.60
|
| Rate for Payer: Cigna of CA PPO |
$1,266.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,455.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,027.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,540.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,284.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,284.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,455.20
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.00
|
| Rate for Payer: United Healthcare All Other HMO |
$856.00
|
| Rate for Payer: United Healthcare HMO Rider |
$856.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$1,540.80 |
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,369.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.80
|
| Rate for Payer: Galaxy Health WC |
$1,455.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,027.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,540.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.40
|
| Rate for Payer: Multiplan Commercial |
$1,284.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,455.20
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$1,540.80 |
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,369.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.80
|
| Rate for Payer: Galaxy Health WC |
$1,455.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,027.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,540.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.40
|
| Rate for Payer: Multiplan Commercial |
$1,284.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,455.20
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,027.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,076.85
|
| Rate for Payer: Blue Shield of California EPN |
$837.17
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,369.60
|
| Rate for Payer: Cigna of CA HMO |
$1,095.68
|
| Rate for Payer: Cigna of CA PPO |
$1,266.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,455.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,027.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,540.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,284.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,141.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,284.00
|
| Rate for Payer: Networks By Design Commercial |
$1,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,455.20
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,027.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,027.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.00
|
| Rate for Payer: United Healthcare All Other HMO |
$856.00
|
| Rate for Payer: United Healthcare HMO Rider |
$856.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$225.64 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,174.20
|
| Rate for Payer: Blue Shield of California EPN |
$923.40
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,520.00
|
| Rate for Payer: Cigna of CA HMO |
$1,216.00
|
| Rate for Payer: Cigna of CA PPO |
$1,406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,615.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,140.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,710.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,425.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,267.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
| Rate for Payer: Networks By Design Commercial |
$1,235.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,615.00
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,140.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,140.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
