|
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 |
$350.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$1,425.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$1,450.47
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
OP
|
$4,240.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,544.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.00
|
| Rate for Payer: Cigna of CA PPO |
$3,137.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| 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 |
$3,604.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,816.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$1,450.47
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Innovage PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.00
|
| 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 |
$3,180.00
|
| Rate for Payer: Networks By Design Commercial |
$2,756.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.00
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,544.00
|
| Rate for Payer: Riverside University Health MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,544.00
|
| 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 LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
IP
|
$4,240.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$3,816.00 |
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Galaxy Health WC |
$3,604.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,544.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,816.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,828.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.00
|
| Rate for Payer: Networks By Design Commercial |
$2,756.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,604.00
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
IP
|
$1,900.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$380.00 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,267.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.00
|
| 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
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$380.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant 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: 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: 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 Transplant Other |
$1,425.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$1,450.47
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,140.00
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
OP
|
$1,582.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$316.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$949.20
|
| Rate for Payer: Blue Shield of California Commercial |
$977.68
|
| Rate for Payer: Blue Shield of California EPN |
$768.85
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,265.60
|
| Rate for Payer: Cigna of CA HMO |
$1,012.48
|
| Rate for Payer: Cigna of CA PPO |
$1,170.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$1,344.70
|
| Rate for Payer: Global Benefits Group Commercial |
$949.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,423.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,186.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,055.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,186.50
|
| Rate for Payer: Networks By Design Commercial |
$1,028.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,344.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$949.20
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$949.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$949.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$791.00
|
| Rate for Payer: United Healthcare All Other HMO |
$791.00
|
| Rate for Payer: United Healthcare HMO Rider |
$791.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$791.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
IP
|
$1,582.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$316.40 |
| Max. Negotiated Rate |
$1,423.80 |
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$632.80
|
| Rate for Payer: Galaxy Health WC |
$1,344.70
|
| Rate for Payer: Global Benefits Group Commercial |
$949.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,423.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,055.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$1,186.50
|
| Rate for Payer: Networks By Design Commercial |
$1,028.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,344.70
|
|
|
HC BREAST TOMO
|
Facility
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,321.43
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,039.25
|
| Rate for Payer: IEHP medi-cal |
$951.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: Riverside University Health MISP |
$1,087.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO
|
Facility
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC BREAST TOMO COMBO
|
Facility
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,321.43
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,039.25
|
| Rate for Payer: IEHP medi-cal |
$951.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: Riverside University Health MISP |
$1,087.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO COMBO
|
Facility
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC BRISK PROFILE
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Central Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
|
HC BRISK PROFILE
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$161.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: BCBS Transplant Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$50.68
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Caremore Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: IEHP medi-cal |
$41.10
|
| Rate for Payer: IEHP Medicare Advantage |
$24.91
|
| Rate for Payer: Innovage PACE Commercial |
$37.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: Riverside University Health MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV BI
|
Facility
OP
|
$8,379.00
|
|
|
Service Code
|
CPT 0781T
|
| Hospital Charge Code |
909010781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,675.80 |
| Max. Negotiated Rate |
$8,389.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,122.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,608.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,608.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,027.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,703.20
|
| Rate for Payer: Cigna of CA PPO |
$6,200.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,122.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,351.60
|
| Rate for Payer: Galaxy Health WC |
$7,122.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,027.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,541.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,284.25
|
| Rate for Payer: IEHP medi-cal |
$2,932.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,675.80
|
| Rate for Payer: Multiplan Commercial |
$6,284.25
|
| Rate for Payer: Networks By Design Commercial |
$5,446.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,122.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,027.40
|
| Rate for Payer: Riverside University Health MISP |
$3,351.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,027.40
|
| 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 Medi-Cal |
$7,122.15
|
| Rate for Payer: Vantage Medical Group Senior |
$7,122.15
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV BI
|
Facility
IP
|
$8,379.00
|
|
|
Service Code
|
CPT 0781T
|
| Hospital Charge Code |
909010781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,675.80 |
| Max. Negotiated Rate |
$7,541.10 |
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,703.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.60
|
| Rate for Payer: Galaxy Health WC |
$7,122.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,027.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,541.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,675.80
|
| Rate for Payer: Multiplan Commercial |
$6,284.25
|
| Rate for Payer: Networks By Design Commercial |
$5,446.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,122.15
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV UNI
|
Facility
IP
|
$4,190.00
|
|
|
Service Code
|
CPT 0782T
|
| Hospital Charge Code |
909010782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.00 |
| Max. Negotiated Rate |
$3,771.00 |
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,352.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,676.00
|
| Rate for Payer: Galaxy Health WC |
$3,561.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,514.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,794.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Multiplan Commercial |
$3,142.50
|
| Rate for Payer: Networks By Design Commercial |
$2,723.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,561.50
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV UNI
|
Facility
OP
|
$4,190.00
|
|
|
Service Code
|
CPT 0782T
|
| Hospital Charge Code |
909010782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.00 |
| Max. Negotiated Rate |
$8,389.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,561.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,304.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,304.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,514.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,352.00
|
| Rate for Payer: Cigna of CA PPO |
$3,100.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,561.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,676.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,676.00
|
| Rate for Payer: Galaxy Health WC |
$3,561.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,514.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,771.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,142.50
|
| Rate for Payer: IEHP medi-cal |
$1,466.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,794.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Multiplan Commercial |
$3,142.50
|
| Rate for Payer: Networks By Design Commercial |
$2,723.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,561.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,514.00
|
| Rate for Payer: Riverside University Health MISP |
$1,676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,514.00
|
| 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 Medi-Cal |
$3,561.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,561.50
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,524.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,715.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,271.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.20
|
| Rate for Payer: Multiplan Commercial |
$1,429.50
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,048.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,143.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,524.80
|
| Rate for Payer: Cigna of CA PPO |
$1,410.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,715.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,429.50
|
| Rate for Payer: IEHP medi-cal |
$667.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,271.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.20
|
| Rate for Payer: Multiplan Commercial |
$1,429.50
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,143.60
|
| Rate for Payer: Riverside University Health MISP |
$762.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.60
|
| 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 |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
OP
|
$7,580.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,443.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,169.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,169.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,548.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,064.00
|
| Rate for Payer: Cigna of CA PPO |
$5,609.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,443.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,032.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,032.00
|
| Rate for Payer: Galaxy Health WC |
$6,443.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,548.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,822.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,685.00
|
| Rate for Payer: IEHP medi-cal |
$2,653.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,055.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: Networks By Design Commercial |
$4,927.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,443.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,548.00
|
| Rate for Payer: Riverside University Health MISP |
$3,032.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,548.00
|
| 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 |
$6,443.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,443.00
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
IP
|
$7,580.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,516.00 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,032.00
|
| Rate for Payer: Galaxy Health WC |
$6,443.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,548.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,822.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,055.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: Networks By Design Commercial |
$4,927.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,443.00
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
OP
|
$7,580.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,516.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,678.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,548.00
|
| 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 |
$4,678.93
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,064.00
|
| Rate for Payer: Cigna of CA PPO |
$5,609.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$6,443.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,548.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,822.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,685.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,673.45
|
| Rate for Payer: IEHP medi-cal |
$7,720.23
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Innovage PACE Commercial |
$7,018.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,055.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,269.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: Networks By Design Commercial |
$4,927.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,443.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,959.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,548.00
|
| Rate for Payer: Riverside University Health MISP |
$5,146.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,548.00
|
| 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 |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
IP
|
$7,580.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,516.00 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,032.00
|
| Rate for Payer: Galaxy Health WC |
$6,443.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,548.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,822.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,055.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: Networks By Design Commercial |
$4,927.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,443.00
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
IP
|
$7,580.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,516.00 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,032.00
|
| Rate for Payer: Galaxy Health WC |
$6,443.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,548.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,822.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,055.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: Networks By Design Commercial |
$4,927.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,443.00
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
OP
|
$7,580.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,516.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,678.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,548.00
|
| 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 |
$4,678.93
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Cash Price |
$3,411.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,064.00
|
| Rate for Payer: Cigna of CA PPO |
$5,609.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$6,443.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,548.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,822.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,685.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,673.45
|
| Rate for Payer: IEHP medi-cal |
$7,720.23
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Innovage PACE Commercial |
$7,018.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,055.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,269.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$5,685.00
|
| Rate for Payer: Networks By Design Commercial |
$4,927.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,443.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,959.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,548.00
|
| Rate for Payer: Riverside University Health MISP |
$5,146.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,548.00
|
| 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 |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
