|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$7,318.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,463.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$4,024.90
|
| Rate for Payer: Cash Price |
$4,024.90
|
| Rate for Payer: Cash Price |
$4,024.90
|
| Rate for Payer: Cigna of CA HMO |
$4,683.52
|
| Rate for Payer: Cigna of CA PPO |
$5,415.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$6,220.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,390.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,881.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: Networks By Design Commercial |
$4,756.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,220.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,390.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$143.84
|
| Rate for Payer: Blue Shield of California EPN |
$95.03
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.56
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$2,771.00 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,174.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,242.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,017.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,793.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,445.00
|
| 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 |
$1,793.00
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: Cigna of CA HMO |
$2,086.40
|
| Rate for Payer: Cigna of CA PPO |
$2,412.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,771.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,771.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,650.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,174.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,997.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,017.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,282.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,282.00
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.00
|
| 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 |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,771.00
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cigna of CA HMO |
$10,254.08
|
| Rate for Payer: Cigna of CA PPO |
$11,856.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,187.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,473.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$12,817.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,613.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
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 |
$8,812.10
|
| 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 URE STNT PLCMNT WO NEPH CATH
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
909050694
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,795.70 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cigna of CA HMO |
$10,254.08
|
| Rate for Payer: Cigna of CA PPO |
$11,856.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,795.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$12,817.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,613.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC URE STNT PLCMNT WO NEPH CATH
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
909050694
|
|
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 |
$8,812.10
|
| 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 URETERAL BIOPSY
|
Facility
|
OP
|
$6,765.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$566.66 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,459.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cigna of CA HMO |
$4,329.60
|
| Rate for Payer: Cigna of CA PPO |
$5,006.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,105.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,459.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,719.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6,459.25
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,593.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$566.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,459.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,459.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,138.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,655.40
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,059.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,459.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6,459.25
|
|
|
HC URETERAL BIOPSY
|
Facility
|
IP
|
$6,765.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$5,750.25 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,706.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,706.00
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,577.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,187.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
|
OP
|
$6,765.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$830.61 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cigna of CA HMO |
$4,329.60
|
| Rate for Payer: Cigna of CA PPO |
$5,006.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$830.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$939.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,059.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
|
IP
|
$6,765.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$5,750.25 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,706.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,706.00
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,577.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,187.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$6,706.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,341.20 |
| Max. Negotiated Rate |
$5,700.10 |
| Rate for Payer: Adventist Health Commercial |
$1,341.20
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,682.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,682.40
|
| Rate for Payer: Galaxy Health WC |
$5,700.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,023.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,151.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.44
|
| Rate for Payer: Multiplan Commercial |
$5,364.80
|
| Rate for Payer: Networks By Design Commercial |
$4,358.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,700.10
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$6,706.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,700.10 |
| Rate for Payer: Adventist Health Commercial |
$1,341.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cigna of CA HMO |
$4,291.84
|
| Rate for Payer: Cigna of CA PPO |
$4,962.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$5,700.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,023.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,472.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$5,364.80
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$4,358.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,700.10
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,023.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,353.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,353.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,353.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$6,706.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,341.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,118.15
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: Cigna of CA HMO |
$4,291.84
|
| Rate for Payer: Cigna of CA PPO |
$4,962.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$5,700.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,023.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,472.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$5,364.80
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$4,358.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,700.10
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,023.60
|
| 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: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$6,706.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,341.20 |
| Max. Negotiated Rate |
$5,700.10 |
| Rate for Payer: Adventist Health Commercial |
$1,341.20
|
| Rate for Payer: Cash Price |
$3,688.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,682.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,682.40
|
| Rate for Payer: Galaxy Health WC |
$5,700.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,023.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,151.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.44
|
| Rate for Payer: Multiplan Commercial |
$5,364.80
|
| Rate for Payer: Networks By Design Commercial |
$4,358.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,700.10
|
|
|
HC URETERAL STENT KIT
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.61
|
| Rate for Payer: Blue Shield of California Commercial |
$560.14
|
| Rate for Payer: Blue Shield of California EPN |
$368.87
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: Cigna of CA HMO |
$531.30
|
| Rate for Payer: Cigna of CA PPO |
$531.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.30
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$379.50
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.85
|
| Rate for Payer: United Healthcare All Other HMO |
$277.26
|
| Rate for Payer: United Healthcare HMO Rider |
$271.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC URETERAL STENT KIT
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: Cigna of CA HMO |
$531.30
|
| Rate for Payer: Cigna of CA PPO |
$531.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$379.50
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.85
|
| Rate for Payer: United Healthcare All Other HMO |
$277.26
|
| Rate for Payer: United Healthcare HMO Rider |
$271.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.57
|
|
|
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 |
$8,812.10
|
| 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 URETER DRAIN OR STENT PLCMNT
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,636.22 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cigna of CA HMO |
$10,254.08
|
| Rate for Payer: Cigna of CA PPO |
$11,856.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,636.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,850.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$12,817.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,613.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
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 |
$165.55
|
| 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 |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| 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 |
$265.10
|
| 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 |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| 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
|
|
