|
HC BRAF PACKAGE
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.24
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.36
|
| Rate for Payer: Heritage Provider Network Senior |
$351.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$227.88 |
| Max. Negotiated Rate |
$944.25 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$810.80
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$852.34
|
| Rate for Payer: Heritage Provider Network Senior |
$852.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.75
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$227.88 |
| Max. Negotiated Rate |
$1,047.53 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$778.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.75
|
| Rate for Payer: Blue Shield of California Commercial |
$714.82
|
| Rate for Payer: Blue Shield of California EPN |
$574.83
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$818.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$779.32
|
| Rate for Payer: Heritage Provider Network Senior |
$779.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$600.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$629.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$629.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.55 |
| Max. Negotiated Rate |
$1,415.25 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,166.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$943.88
|
| Rate for Payer: Blue Shield of California Commercial |
$814.08
|
| Rate for Payer: Blue Shield of California EPN |
$654.66
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,226.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,168.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,168.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$900.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$943.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$943.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
|
IP
|
$1,887.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.55 |
| Max. Negotiated Rate |
$1,415.25 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.23
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,277.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,277.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.75
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,077.54
|
| Rate for Payer: Cash Price |
$1,451.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,184.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.50
|
| Rate for Payer: Multiplan Commercial |
$2,419.50
|
|
|
HC BRAIN IMAGING (3D)
|
Facility
|
OP
|
$3,226.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
909301409
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$583.91 |
| Max. Negotiated Rate |
$2,742.10 |
| Rate for Payer: Adventist Health Commercial |
$645.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,993.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,742.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,774.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,419.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,613.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,967.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,574.29
|
| Rate for Payer: Cash Price |
$1,451.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,096.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,742.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,742.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,742.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,096.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,996.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,996.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,538.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$583.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,258.20
|
| Rate for Payer: Multiplan Commercial |
$2,419.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,613.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,613.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,742.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,742.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,742.10
|
|
|
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 |
$1,075.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,188.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,672.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,822.93
|
| Rate for Payer: Blue Shield of California EPN |
$2,246.45
|
| Rate for Payer: Cash Price |
$2,674.35
|
| Rate for Payer: Cash Price |
$2,674.35
|
| Rate for Payer: Cash Price |
$2,674.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,862.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,035.90
|
| 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) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,834.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,791.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,485.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$4,457.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,565.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,565.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,827.29
|
| Rate for Payer: Cash Price |
$2,674.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,023.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,023.41
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$441.14
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.33
|
| 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 |
$3,672.00
|
| 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 |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$326.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$211.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$233.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$554.80
|
| Rate for Payer: Blue Shield of California EPN |
$441.50
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$759.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| 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) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$557.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$700.80
|
| Rate for Payer: TriValley Medical Group Senior |
$700.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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: Aetna of CA Non-Gatekeeper |
$752.19
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$790.74
|
| Rate for Payer: Heritage Provider Network Senior |
$790.74
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$1,168.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$233.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$759.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$722.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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: Aetna of CA Non-Gatekeeper |
$752.19
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$790.74
|
| Rate for Payer: Heritage Provider Network Senior |
$790.74
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$1,618.37
|
| Rate for Payer: Cash Price |
$1,130.85
|
| Rate for Payer: Cash Price |
$1,130.85
|
| 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 Foundation Hospitals 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 MRI
|
Facility
|
OP
|
$2,513.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$502.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,130.85
|
| Rate for Payer: Cash Price |
$1,130.85
|
| Rate for Payer: Cash Price |
$1,130.85
|
| Rate for Payer: Cash Price |
$1,130.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| 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) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,198.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,610.91
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,795.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,795.94
|
| Rate for Payer: Kaiser Foundation Hospitals 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 STEREOTACTIC GUIDANCE
|
Facility
|
OP
|
$5,607.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,465.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,644.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,470.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,339.52
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,408.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,408.16
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$376.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$416.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,285.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,352.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| 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) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$992.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$376.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$910.78
|
| Rate for Payer: TriValley Medical Group Senior |
$910.78
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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 |
$378.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,292.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,359.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| 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) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$997.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$378.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,124.23
|
| Rate for Payer: TriValley Medical Group Senior |
$2,124.23
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,347.25
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,416.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,416.28
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$1,642.64
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,329.53
|
| 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 |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| 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 Medicare Advantage |
$2,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,645.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,645.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,267.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$1,711.75
|
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,799.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,799.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.50
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
|
