|
HC BURR HOLES/ICP
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Central Health Plan Commercial |
$842.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$947.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
|
|
HC BURR HOLES/ICP
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 61105
|
| Hospital Charge Code |
988161105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,317.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$579.15
|
| 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 |
$631.80
|
| 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 |
$473.85
|
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Central Health Plan Commercial |
$842.40
|
| Rate for Payer: Cigna of CA PPO |
$779.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.05
|
| Rate for Payer: Dignity Health Media |
$895.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$947.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$789.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
| Rate for Payer: Riverside University Health System MISP |
$421.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.80
|
| 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 |
$895.05
|
| Rate for Payer: Vantage Medical Group Senior |
$895.05
|
|
|
HC BX BONE OPEN SUPERFICIAL
|
Facility
|
IP
|
$8,814.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
902320240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,762.80 |
| Max. Negotiated Rate |
$7,932.60 |
| Rate for Payer: Cash Price |
$3,966.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,051.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,525.60
|
| Rate for Payer: Galaxy Health WC |
$7,491.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,288.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,932.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,878.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,358.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Multiplan Commercial |
$6,610.50
|
| Rate for Payer: Networks By Design Commercial |
$5,729.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,491.90
|
|
|
HC BX BONE OPEN SUPERFICIAL
|
Facility
|
OP
|
$8,814.00
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
902320240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| 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 |
$5,288.40
|
| 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 |
$3,550.26
|
| Rate for Payer: Cash Price |
$3,966.30
|
| Rate for Payer: Cash Price |
$3,966.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,051.20
|
| Rate for Payer: Cigna of CA PPO |
$6,522.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$7,491.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,288.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,932.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,610.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,857.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,878.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$6,610.50
|
| Rate for Payer: Networks By Design Commercial |
$5,729.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,491.90
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,288.40
|
| 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 |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$4,593.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$4,133.70 |
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,674.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,837.20
|
| Rate for Payer: Galaxy Health WC |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,133.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.60
|
| Rate for Payer: Multiplan Commercial |
$3,444.75
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$4,593.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.20 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,755.80
|
| 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 |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,674.40
|
| Rate for Payer: Cigna of CA PPO |
$3,398.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| 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 |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,133.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,444.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (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 |
$3,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.60
|
| 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 |
$3,444.75
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| 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 BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$4,028.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$805.60 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,416.80
|
| 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 |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,222.40
|
| Rate for Payer: Cigna of CA PPO |
$2,980.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| 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 |
$3,423.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,416.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,625.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,021.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (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 |
$2,686.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.60
|
| 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 |
$3,021.00
|
| Rate for Payer: Networks By Design Commercial |
$2,618.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,423.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,416.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| 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 BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$4,028.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$805.60 |
| Max. Negotiated Rate |
$3,625.20 |
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,222.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,611.20
|
| Rate for Payer: Galaxy Health WC |
$3,423.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,416.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,686.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,534.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.60
|
| Rate for Payer: Multiplan Commercial |
$3,021.00
|
| Rate for Payer: Networks By Design Commercial |
$2,618.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,423.80
|
|
|
HC BX BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$5,036.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,007.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$3,021.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,112.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,447.50
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,028.80
|
| Rate for Payer: Cigna of CA HMO |
$3,223.04
|
| Rate for Payer: Cigna of CA PPO |
$3,726.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| 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 |
$4,280.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,021.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,532.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,777.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (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 |
$3,359.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,166.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.20
|
| 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 |
$3,777.00
|
| Rate for Payer: Networks By Design Commercial |
$3,273.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,280.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,021.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,021.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,518.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,518.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,518.00
|
| 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 BX BREAST 1ST LESION US IMAG
|
Facility
|
IP
|
$5,036.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,007.20 |
| Max. Negotiated Rate |
$4,532.40 |
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,028.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,014.40
|
| Rate for Payer: Galaxy Health WC |
$4,280.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,021.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,532.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,359.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.20
|
| Rate for Payer: Multiplan Commercial |
$3,777.00
|
| Rate for Payer: Networks By Design Commercial |
$3,273.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,280.60
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$4,833.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,108.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,658.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,658.15
|
| 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 |
$2,899.80
|
| 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 |
$2,174.85
|
| Rate for Payer: Cash Price |
$2,174.85
|
| Rate for Payer: Cash Price |
$2,174.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,866.40
|
| Rate for Payer: Cigna of CA PPO |
$3,576.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,108.05
|
| Rate for Payer: Dignity Health Media |
$4,108.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,108.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,933.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,933.20
|
| Rate for Payer: Galaxy Health WC |
$4,108.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,899.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,349.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,624.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,691.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,223.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.60
|
| Rate for Payer: Multiplan Commercial |
$3,624.75
|
| Rate for Payer: Networks By Design Commercial |
$3,141.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,108.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,933.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,899.80
|
| 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 |
$4,108.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,108.05
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$4,833.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$966.60 |
| Max. Negotiated Rate |
$4,349.70 |
| Rate for Payer: Cash Price |
$2,174.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,866.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,933.20
|
| Rate for Payer: Galaxy Health WC |
$4,108.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,899.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,349.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,223.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,841.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.60
|
| Rate for Payer: Multiplan Commercial |
$3,624.75
|
| Rate for Payer: Networks By Design Commercial |
$3,141.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,108.05
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$4,028.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$805.60 |
| Max. Negotiated Rate |
$3,625.20 |
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,222.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,611.20
|
| Rate for Payer: Galaxy Health WC |
$3,423.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,416.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,625.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,686.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,534.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.60
|
| Rate for Payer: Multiplan Commercial |
$3,021.00
|
| Rate for Payer: Networks By Design Commercial |
$2,618.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,423.80
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$4,028.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$805.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,423.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,215.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,215.40
|
| 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 |
$2,416.80
|
| 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 |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,812.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,222.40
|
| Rate for Payer: Cigna of CA PPO |
$2,980.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,423.80
|
| Rate for Payer: Dignity Health Media |
$3,423.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,611.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,611.20
|
| Rate for Payer: Galaxy Health WC |
$3,423.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,416.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,625.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,021.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,409.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,686.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.60
|
| Rate for Payer: Multiplan Commercial |
$3,021.00
|
| Rate for Payer: Networks By Design Commercial |
$2,618.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,423.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,611.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,416.80
|
| 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 |
$3,423.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,423.80
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$5,036.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$962.73 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,280.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,769.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,769.80
|
| 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 |
$3,021.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,112.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,447.50
|
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,028.80
|
| Rate for Payer: Cigna of CA HMO |
$3,223.04
|
| Rate for Payer: Cigna of CA PPO |
$3,726.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,280.60
|
| Rate for Payer: Dignity Health Media |
$4,280.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,280.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,014.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,014.40
|
| Rate for Payer: Galaxy Health WC |
$4,280.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,021.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,532.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,777.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,762.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,359.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$962.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.20
|
| Rate for Payer: Multiplan Commercial |
$3,777.00
|
| Rate for Payer: Networks By Design Commercial |
$3,273.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,280.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,014.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,021.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,021.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,518.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,518.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,518.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,280.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,280.60
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$5,036.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,007.20 |
| Max. Negotiated Rate |
$4,532.40 |
| Rate for Payer: Cash Price |
$2,266.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,028.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,014.40
|
| Rate for Payer: Galaxy Health WC |
$4,280.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,021.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,532.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,359.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,007.20
|
| Rate for Payer: Multiplan Commercial |
$3,777.00
|
| Rate for Payer: Networks By Design Commercial |
$3,273.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,280.60
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$3,322.13 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$1,710.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,280.80
|
| Rate for Payer: Cigna of CA PPO |
$2,109.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| 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 |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,565.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,138.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.20
|
| 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 |
$2,138.25
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,710.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.50
|
| 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 BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$570.20 |
| Max. Negotiated Rate |
$2,565.90 |
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.40
|
| Rate for Payer: Galaxy Health WC |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,565.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.20
|
| Rate for Payer: Multiplan Commercial |
$2,138.25
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$1,710.60
|
| 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: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,280.80
|
| Rate for Payer: Cigna of CA PPO |
$2,109.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| 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 |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,565.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,138.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.20
|
| 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 |
$2,138.25
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,710.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| 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 BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.20 |
| Max. Negotiated Rate |
$2,565.90 |
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.40
|
| Rate for Payer: Galaxy Health WC |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,565.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.20
|
| Rate for Payer: Multiplan Commercial |
$2,138.25
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.20 |
| Max. Negotiated Rate |
$2,565.90 |
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.40
|
| Rate for Payer: Galaxy Health WC |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,565.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.20
|
| Rate for Payer: Multiplan Commercial |
$2,138.25
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$3,342.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$1,710.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,793.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,394.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Cash Price |
$1,282.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,280.80
|
| Rate for Payer: Cigna of CA HMO |
$1,824.64
|
| Rate for Payer: Cigna of CA PPO |
$2,109.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| 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 |
$2,423.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,565.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,138.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,901.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.20
|
| 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 |
$2,138.25
|
| Rate for Payer: Networks By Design Commercial |
$1,853.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,423.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,710.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,710.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,425.50
|
| 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 BX OF LACRIMAL GLAND
|
Facility
|
OP
|
$7,447.00
|
|
|
Service Code
|
CPT 68510
|
| Hospital Charge Code |
988168510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$904.72 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| 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 |
$4,468.20
|
| 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: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,957.60
|
| Rate for Payer: Cigna of CA PPO |
$5,510.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,702.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,585.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$5,585.25
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,468.20
|
| 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 |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC BX OF LACRIMAL GLAND
|
Facility
|
IP
|
$7,447.00
|
|
|
Service Code
|
CPT 68510
|
| Hospital Charge Code |
988168510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,489.40 |
| Max. Negotiated Rate |
$6,702.30 |
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,978.80
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,702.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,837.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.40
|
| Rate for Payer: Multiplan Commercial |
$5,585.25
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
|
|
HC BX OF PLEURA PERC NEEDLE
|
Facility
|
IP
|
$4,836.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
900831706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$967.20 |
| Max. Negotiated Rate |
$4,352.40 |
| Rate for Payer: Cash Price |
$2,176.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,868.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,934.40
|
| Rate for Payer: Galaxy Health WC |
$4,110.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,901.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,352.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,225.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,842.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.20
|
| Rate for Payer: Multiplan Commercial |
$3,627.00
|
| Rate for Payer: Networks By Design Commercial |
$3,143.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,110.60
|
|
