|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| 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 |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| 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/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,795.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,030.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| 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 |
$8,011.00
|
| 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 |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
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 |
$7,209.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,452.98
|
| 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
|
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 |
$3,044.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,991.35
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| 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 |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,378.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7,585.79
|
| 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/Senior |
$11,309.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$566.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,654.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,689.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,240.87
|
| 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 |
$3,382.50
|
| 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 |
$6,896.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
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 |
$3,044.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,991.35
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| 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 |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| 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/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$830.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$939.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| 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 |
$3,382.50
|
| 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 |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
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 |
$3,017.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,694.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,258.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,956.54
|
| 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
|
361
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,341.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,303.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$3,017.70
|
| Rate for Payer: Cash Price |
$3,017.70
|
| Rate for Payer: Cash Price |
$3,017.70
|
| 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 |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,694.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| 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/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,258.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| 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 |
$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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
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 |
$3,017.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,694.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,258.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,956.54
|
| 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 |
$321.35 |
| Max. Negotiated Rate |
$5,700.10 |
| Rate for Payer: Adventist Health Commercial |
$1,341.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$3,017.70
|
| Rate for Payer: Cash Price |
$3,017.70
|
| Rate for Payer: Cash Price |
$3,017.70
|
| 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 |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,694.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| 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/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,258.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO |
$531.30
|
| Rate for Payer: Cigna of CA PPO |
$531.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.81
|
| 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 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 |
$459.42
|
| Rate for Payer: Blue Shield of California Commercial |
$384.81
|
| Rate for Payer: Blue Shield of California Commercial |
$583.67
|
| Rate for Payer: Cash Price |
$341.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$275.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.81
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| 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 |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| 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/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,636.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,850.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| 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 |
$8,011.00
|
| 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 |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,452.98
|
| 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
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$479.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| 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 |
$150.50
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$191.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.59
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 |
$241.00
|
| 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
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC URIC ACID
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| 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 Medi-Cal |
$4.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.13
|
| Rate for Payer: Blue Shield of California Commercial |
$62.70
|
| Rate for Payer: Blue Shield of California Commercial |
$33.46
|
| Rate for Payer: Blue Shield of California Commercial |
$94.79
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.46
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| 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 Medi-Cal |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| 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 Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.52
|
| 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 Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| 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 |
$48.99 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| 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 Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$12.45
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Blue Shield of California Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.59
|
| Rate for Payer: EPIC Health Plan Senior |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| 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 All Other HMO |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.08
|
| 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 Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| 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 Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.59
|
| Rate for Payer: EPIC Health Plan Senior |
$5.59
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| 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 Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| 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 Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.08
|
| 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 Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
| 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: Cash Price |
$55.80
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.06
|
| 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
|
|
