|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,204.40 |
| Max. Negotiated Rate |
$13,618.70 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,408.80
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,104.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,917.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Multiplan Commercial |
$12,817.60
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Senior |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$424.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$186.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.70
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$462.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC URIC ACID
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$44.69 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.69
|
| Rate for Payer: Blue Shield of California Commercial |
$32.11
|
| Rate for Payer: Blue Shield of California EPN |
$21.22
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3.66
|
| Rate for Payer: United Healthcare HMO Rider |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
HC URIC ACID
|
Facility
|
IP
|
$99.20
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$84.32 |
| Rate for Payer: Adventist Health Commercial |
$19.84
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.68
|
| Rate for Payer: EPIC Health Plan Senior |
$39.68
|
| Rate for Payer: Galaxy Health WC |
$84.32
|
| Rate for Payer: Global Benefits Group Commercial |
$59.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.81
|
| Rate for Payer: Multiplan Commercial |
$79.36
|
| Rate for Payer: Networks By Design Commercial |
$64.48
|
| Rate for Payer: Prime Health Services Commercial |
$84.32
|
|
|
HC URIC ACID BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC URIC ACID BODY FLUID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC URIC ACID URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.47
|
| Rate for Payer: Blue Shield of California Commercial |
$89.65
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.47
|
| Rate for Payer: Blue Shield of California Commercial |
$89.65
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC URINARY CATH 3.5FR SILICONE
|
Facility
|
OP
|
$138.02
|
|
| Hospital Charge Code |
901698493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.32 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.76
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: Cigna of CA HMO |
$88.33
|
| Rate for Payer: Cigna of CA PPO |
$102.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.21
|
| Rate for Payer: EPIC Health Plan Senior |
$55.21
|
| Rate for Payer: Galaxy Health WC |
$117.32
|
| Rate for Payer: Global Benefits Group Commercial |
$82.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.61
|
| Rate for Payer: Multiplan Commercial |
$110.42
|
| Rate for Payer: Networks By Design Commercial |
$89.71
|
| Rate for Payer: Prime Health Services Commercial |
$117.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.01
|
| Rate for Payer: United Healthcare All Other HMO |
$69.01
|
| Rate for Payer: United Healthcare HMO Rider |
$69.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.32
|
| Rate for Payer: Vantage Medical Group Senior |
$117.32
|
|
|
HC URINARY CATH 3.5FR SILICONE
|
Facility
|
IP
|
$138.02
|
|
| Hospital Charge Code |
901698493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.32 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.21
|
| Rate for Payer: EPIC Health Plan Senior |
$55.21
|
| Rate for Payer: Galaxy Health WC |
$117.32
|
| Rate for Payer: Global Benefits Group Commercial |
$82.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.42
|
| Rate for Payer: Networks By Design Commercial |
$89.71
|
| Rate for Payer: Prime Health Services Commercial |
$117.32
|
|
|
HC URINARY CATH 5.0 SILICONE
|
Facility
|
IP
|
$83.60
|
|
| Hospital Charge Code |
901698568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Adventist Health Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.44
|
| Rate for Payer: EPIC Health Plan Senior |
$33.44
|
| Rate for Payer: Galaxy Health WC |
$71.06
|
| Rate for Payer: Global Benefits Group Commercial |
$50.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$66.88
|
| Rate for Payer: Networks By Design Commercial |
$54.34
|
| Rate for Payer: Prime Health Services Commercial |
$71.06
|
|
|
HC URINARY CATH 5.0 SILICONE
|
Facility
|
OP
|
$83.60
|
|
| Hospital Charge Code |
901698568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Adventist Health Commercial |
$16.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.34
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO |
$53.50
|
| Rate for Payer: Cigna of CA PPO |
$61.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.44
|
| Rate for Payer: EPIC Health Plan Senior |
$33.44
|
| Rate for Payer: Galaxy Health WC |
$71.06
|
| Rate for Payer: Global Benefits Group Commercial |
$50.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.52
|
| Rate for Payer: Multiplan Commercial |
$66.88
|
| Rate for Payer: Networks By Design Commercial |
$54.34
|
| Rate for Payer: Prime Health Services Commercial |
$71.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.80
|
| Rate for Payer: United Healthcare All Other HMO |
$41.80
|
| Rate for Payer: United Healthcare HMO Rider |
$41.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.06
|
| Rate for Payer: Vantage Medical Group Senior |
$71.06
|
|
|
HC URINARY DRAIN CATH KIT 8FR
|
Facility
|
OP
|
$196.00
|
|
| Hospital Charge Code |
901698629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.36
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98.00
|
| Rate for Payer: United Healthcare HMO Rider |
$98.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC URINARY DRAIN CATH KIT 8FR
|
Facility
|
IP
|
$196.00
|
|
| Hospital Charge Code |
901698629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC URINARY DRAIN KIT W/5FR CATH
|
Facility
|
OP
|
$248.92
|
|
| Hospital Charge Code |
901698447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$211.58 |
| Rate for Payer: Adventist Health Commercial |
$49.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.86
|
| Rate for Payer: Cash Price |
$112.01
|
| Rate for Payer: Cigna of CA HMO |
$159.31
|
| Rate for Payer: Cigna of CA PPO |
$184.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.57
|
| Rate for Payer: EPIC Health Plan Senior |
$99.57
|
| Rate for Payer: Galaxy Health WC |
$211.58
|
| Rate for Payer: Global Benefits Group Commercial |
$149.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.24
|
| Rate for Payer: Multiplan Commercial |
$199.14
|
| Rate for Payer: Networks By Design Commercial |
$161.80
|
| Rate for Payer: Prime Health Services Commercial |
$211.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.46
|
| Rate for Payer: United Healthcare All Other HMO |
$124.46
|
| Rate for Payer: United Healthcare HMO Rider |
$124.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.58
|
| Rate for Payer: Vantage Medical Group Senior |
$211.58
|
|
|
HC URINARY DRAIN KIT W/5FR CATH
|
Facility
|
IP
|
$248.92
|
|
| Hospital Charge Code |
901698447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$211.58 |
| Rate for Payer: Adventist Health Commercial |
$49.78
|
| Rate for Payer: Cash Price |
$112.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.57
|
| Rate for Payer: EPIC Health Plan Senior |
$99.57
|
| Rate for Payer: Galaxy Health WC |
$211.58
|
| Rate for Payer: Global Benefits Group Commercial |
$149.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.74
|
| Rate for Payer: Multiplan Commercial |
$199.14
|
| Rate for Payer: Networks By Design Commercial |
$161.80
|
| Rate for Payer: Prime Health Services Commercial |
$211.58
|
|
|
HC URINARY DRAIN KIT W/CATH 5.0
|
Facility
|
OP
|
$196.00
|
|
| Hospital Charge Code |
901698567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.36
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98.00
|
| Rate for Payer: United Healthcare HMO Rider |
$98.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC URINARY DRAIN KIT W/CATH 5.0
|
Facility
|
IP
|
$196.00
|
|
| Hospital Charge Code |
901698567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
