|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$2,294.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,720.50 |
| Rate for Payer: Adventist Health Commercial |
$458.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,575.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.54
|
| Rate for Payer: Blue Shield of California Commercial |
$399.50
|
| Rate for Payer: Blue Shield of California EPN |
$227.18
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,491.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,491.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,419.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,419.99
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,720.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.95 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.96
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$564.62
|
| Rate for Payer: Heritage Provider Network Senior |
$564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.50
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.56
|
| Rate for Payer: Blue Shield of California Commercial |
$346.28
|
| Rate for Payer: Blue Shield of California EPN |
$196.92
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$542.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.25
|
| Rate for Payer: Heritage Provider Network Senior |
$516.25
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BOTOX INJECTION
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$379.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,550.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,413.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,298.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,005.82 |
| Max. Negotiated Rate |
$4,167.75 |
| Rate for Payer: Adventist Health Commercial |
$1,111.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,817.66
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,762.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,762.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.25
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$486.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,670.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,580.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,459.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,505.41
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Adventist Health Commercial |
$486.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,670.78
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,646.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.00
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
|
|
HC BRAF
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.56 |
| Max. Negotiated Rate |
$406.35 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.35
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$118.57
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Senior |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.04
|
| Rate for Payer: Heritage Provider Network Senior |
$125.04
|
| Rate for Payer: Humana Medicare |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAF
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$212.25 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.42
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.59
|
| Rate for Payer: Heritage Provider Network Senior |
$191.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.75
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
|
|
HC BRAF PACKAGE
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.56 |
| Max. Negotiated Rate |
$406.35 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.35
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$118.57
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Senior |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.04
|
| Rate for Payer: Heritage Provider Network Senior |
$125.04
|
| Rate for Payer: Humana Medicare |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAF PACKAGE
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$212.25 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.42
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.59
|
| Rate for Payer: Heritage Provider Network Senior |
$191.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.75
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.69 |
| Max. Negotiated Rate |
$864.75 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.11
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$780.58
|
| Rate for Payer: Heritage Provider Network Senior |
$780.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.25
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.69 |
| Max. Negotiated Rate |
$1,283.13 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$379.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$693.97
|
| Rate for Payer: Blue Shield of California EPN |
$394.64
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$749.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.71
|
| Rate for Payer: Heritage Provider Network Senior |
$713.71
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$2,312.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$418.47 |
| Max. Negotiated Rate |
$1,734.00 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,588.34
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,565.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,565.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
OP
|
$2,312.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$248.32 |
| Max. Negotiated Rate |
$1,734.00 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$651.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,588.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$790.34
|
| Rate for Payer: Blue Shield of California EPN |
$449.44
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,502.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,431.13
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$5,440.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,737.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,536.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,682.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3,682.88
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,622.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: Multiplan Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,975.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,817.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$5,440.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$984.64 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,737.28
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,682.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3,682.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.00
|
| Rate for Payer: Multiplan Commercial |
$4,080.00
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$532.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$344.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$470.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$532.95
|
| Rate for Payer: Dignity Health Senior |
$532.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.11
|
| Rate for Payer: Heritage Provider Network Senior |
$388.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$532.95
|
| Rate for Payer: Vantage Medical Group Senior |
$532.95
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$695.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$515.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$388.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$357.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$695.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$185.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$380.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,305.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,179.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,115.30
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Adventist Health Commercial |
$380.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,305.30
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,286.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
|
