|
HC BRAIN IMAGING (3D)
|
Facility
|
IP
|
$3,226.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$583.91 |
| Max. Negotiated Rate |
$2,419.50 |
| Rate for Payer: Adventist Health Commercial |
$645.20
|
| Rate for Payer: Cash Price |
$1,774.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,184.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,184.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$583.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.50
|
| Rate for Payer: Multiplan Commercial |
$2,419.50
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
IP
|
$5,943.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,075.68 |
| Max. Negotiated Rate |
$4,457.25 |
| Rate for Payer: Adventist Health Commercial |
$1,188.60
|
| Rate for Payer: Cash Price |
$3,268.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,023.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,023.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,485.75
|
| Rate for Payer: Multiplan Commercial |
$4,457.25
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
|
OP
|
$5,943.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,188.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,082.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,268.65
|
| Rate for Payer: Cash Price |
$3,268.65
|
| Rate for Payer: Cash Price |
$3,268.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,862.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Senior |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,865.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,023.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,023.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,834.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,595.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,485.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,130.50
|
| Rate for Payer: Multiplan Commercial |
$4,457.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,138.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,967.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$582.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$582.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$582.25
|
| Rate for Payer: Dignity Health Senior |
$582.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.01
|
| Rate for Payer: Heritage Provider Network Senior |
$424.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$479.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$479.50
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$582.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$582.25
|
| Rate for Payer: Vantage Medical Group Senior |
$582.25
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,168.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$233.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$802.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$759.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$790.74
|
| Rate for Payer: Heritage Provider Network Senior |
$790.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$557.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$420.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$386.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
OP
|
$1,168.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$233.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$802.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$759.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$722.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,168.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Adventist Health Commercial |
$233.60
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$790.74
|
| Rate for Payer: Heritage Provider Network Senior |
$790.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
|
IP
|
$1,168.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Adventist Health Commercial |
$233.60
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$790.74
|
| Rate for Payer: Heritage Provider Network Senior |
$790.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
OP
|
$2,513.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$502.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,726.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,532.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,226.34
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$192.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,198.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$1,884.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,256.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,256.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
|
IP
|
$2,513.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$454.85 |
| Max. Negotiated Rate |
$1,884.75 |
| Rate for Payer: Adventist Health Commercial |
$502.60
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: Cash Price |
$1,382.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,701.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,701.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.25
|
| Rate for Payer: Multiplan Commercial |
$1,884.75
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$5,607.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,852.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,644.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,470.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$396.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
|
IP
|
$5,607.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,014.87 |
| Max. Negotiated Rate |
$4,205.25 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,795.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,795.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.75
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
IP
|
$2,080.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.48 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Adventist Health Commercial |
$416.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,408.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,408.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
|
OP
|
$2,080.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$416.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,428.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,268.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,015.04
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,352.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,287.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$771.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$893.98
|
| Rate for Payer: TriValley Medical Group Senior |
$893.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,040.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$378.65 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,416.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,416.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,437.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,276.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.90
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,359.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,294.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,294.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$997.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,058.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,058.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,046.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,046.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BREAST TOMO
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$481.10 |
| Max. Negotiated Rate |
$2,259.30 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,826.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,727.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Senior |
$2,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,727.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,645.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,645.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,267.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,860.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,329.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC BREAST TOMO
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$481.10 |
| Max. Negotiated Rate |
$1,993.50 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,799.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,799.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$481.10 |
| Max. Negotiated Rate |
$2,259.30 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,826.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,727.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Senior |
$2,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,727.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,645.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,645.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,267.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,860.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,329.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$481.10 |
| Max. Negotiated Rate |
$1,993.50 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,799.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,799.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.11 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.95
|
| Rate for Payer: Heritage Provider Network Senior |
$280.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$221.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$116.02
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.88
|
| Rate for Payer: Heritage Provider Network Senior |
$256.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$197.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$207.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC BRISK PROFILE
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$237.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$305.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.63
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$275.45
|
| Rate for Payer: Heritage Provider Network Senior |
$275.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$212.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$24.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRISK PROFILE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.26
|
| Rate for Payer: Heritage Provider Network Senior |
$301.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
|
