|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
IP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$4,653.75 |
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,190.00
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,085.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Multiplan Commercial |
$4,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
IP
|
$9,064.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,175.36 |
| Max. Negotiated Rate |
$7,704.40 |
| Rate for Payer: Cash Price |
$4,078.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,625.60
|
| Rate for Payer: Galaxy Health WC |
$7,704.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,438.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,045.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,453.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,175.36
|
| Rate for Payer: Multiplan Commercial |
$7,251.20
|
| Rate for Payer: Networks By Design Commercial |
$5,891.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,704.40
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
OP
|
$6,057.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,634.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cigna of CA PPO |
$4,482.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$5,148.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,634.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,542.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,847.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,847.45
|
| Rate for Payer: IEHP Medi-Cal |
$7,751.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,751.75
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,040.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$4,845.60
|
| Rate for Payer: Networks By Design Commercial |
$3,937.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,148.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,263.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC UREA NITROGEN, UR
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$43.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.30
|
| Rate for Payer: BCBS Transplant Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Media |
$5.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.56
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.12
|
| Rate for Payer: IEHP Medi-Cal |
$9.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$9.01
|
| Rate for Payer: IEHP Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| 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 |
$3.84
|
| 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 |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| 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: 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
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,431.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,220.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,220.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,422.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Dignity Health Media |
$3,431.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,431.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,027.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,997.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,422.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,422.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,431.45
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.88 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,934.08 |
| Max. Negotiated Rate |
$13,933.20 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,245.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: IEHP Medi-Cal |
$7,056.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,473.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URE STNT PLCMNT WO NEPH CATH
|
Facility
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
909050694
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,934.08 |
| Max. Negotiated Rate |
$13,933.20 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,245.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URE STNT PLCMNT WO NEPH CATH
|
Facility
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
909050694
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: IEHP Medi-Cal |
$7,056.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URETERAL BIOPSY
|
Facility
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,026.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,602.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,602.62
|
| Rate for Payer: IEHP Medi-Cal |
$10,473.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$10,473.32
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,026.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC URETERAL BIOPSY
|
Facility
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.72 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.38 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,026.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: IEHP Medi-Cal |
$7,056.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$939.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,026.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.72 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC URETERAL DILATION
|
Facility
OP
|
$8,306.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,983.60
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cigna of CA PPO |
$6,146.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,229.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,983.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,153.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,153.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,153.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,153.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC URETERAL DILATION
|
Facility
IP
|
$8,306.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,993.44 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,164.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
|
|
HC URETERAL DILATION
|
Facility
OP
|
$8,306.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,948.71
|
| Rate for Payer: BCBS Transplant Transplant |
$4,983.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cigna of CA PPO |
$6,146.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,229.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: IEHP Medi-Cal |
$500.24
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$500.24
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,983.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC URETERAL DILATION
|
Facility
IP
|
$8,306.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,993.44 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,164.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,934.08 |
| Max. Negotiated Rate |
$13,933.20 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,245.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: IEHP Medi-Cal |
$7,056.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,850.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.96 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$300.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$194.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$194.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$212.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.90
|
| Rate for Payer: Dignity Health Media |
$300.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$265.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.96
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.90
|
| Rate for Payer: Vantage Medical Group Senior |
$300.90
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.96 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.96
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$435.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$311.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$340.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.95
|
| Rate for Payer: Dignity Health Media |
$481.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$425.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$340.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.95
|
| Rate for Payer: Vantage Medical Group Senior |
$481.95
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC URIC ACID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.28
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Media |
$4.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.41
|
| Rate for Payer: IEHP Medi-Cal |
$7.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3.66
|
| Rate for Payer: United Healthcare HMO Rider |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
