|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000308
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,514.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
944000111
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,514.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,514.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000308
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$882.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$430.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,493.22
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$882.72
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$935.68
|
| Rate for Payer: Riverside University Health System MISP |
$970.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
944000111
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$882.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$430.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,493.22
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Cash Price |
$1,155.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,796.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$882.72
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$935.68
|
| Rate for Payer: Riverside University Health System MISP |
$970.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC UNSCH EMER DIAL ESRD OP NO CRT
|
Facility
|
IP
|
$3,713.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
940110257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$742.60 |
| Max. Negotiated Rate |
$3,341.70 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,599.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.20
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,357.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,190.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
|
|
HC UNSCH EMER DIAL ESRD OP NO CRT
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
940110257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$742.60 |
| Max. Negotiated Rate |
$3,341.70 |
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$882.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,394.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,797.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: Cigna of CA HMO |
$2,376.32
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,599.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,357.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,347.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$882.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Prime Health Services Medicare |
$935.68
|
| Rate for Payer: Riverside University Health System MISP |
$970.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
915356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.84
|
| Rate for Payer: Blue Shield of California Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California EPN |
$76.10
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Riverside University Health System MISP |
$60.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Blue Shield of California Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California EPN |
$76.10
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
915356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Blue Shield of California Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California EPN |
$76.10
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.84
|
| Rate for Payer: Blue Shield of California Commercial |
$121.10
|
| Rate for Payer: Blue Shield of California EPN |
$76.10
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Riverside University Health System MISP |
$60.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,801.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,984.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$1,953.92
|
| Rate for Payer: Cigna of CA HMO |
$1,306.24
|
| Rate for Payer: Cigna of CA PPO |
$2,259.22
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,428.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,296.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,984.45
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,526.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,020.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,536.80
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,978.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,315.75
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,210.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,210.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,978.90 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,978.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,608.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.20
|
| Rate for Payer: Multiplan Commercial |
$3,315.75
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,978.90 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,978.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,608.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.20
|
| Rate for Payer: Multiplan Commercial |
$3,315.75
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,812.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,160.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,536.80
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,978.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,315.75
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,652.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
IP
|
$7,319.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,463.80 |
| Max. Negotiated Rate |
$6,587.10 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,927.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,927.60
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,647.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,318.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$7,319.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| Rate for Payer: Adventist Health Commercial |
$978.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,958.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,958.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,912.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: Cigna of CA HMO |
$3,130.24
|
| Rate for Payer: Cigna of CA HMO |
$4,684.16
|
| Rate for Payer: Cigna of CA PPO |
$5,416.06
|
| Rate for Payer: Cigna of CA PPO |
$3,619.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,423.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,401.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,105.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,647.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Multiplan Commercial |
$3,668.25
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,958.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
| Rate for Payer: Prime Health Services Medicare |
$5,256.31
|
| Rate for Payer: Prime Health Services Medicare |
$5,256.31
|
| Rate for Payer: Riverside University Health System MISP |
$5,454.66
|
| Rate for Payer: Riverside University Health System MISP |
$5,454.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,934.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,391.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,659.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,445.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California Commercial |
$135.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$85.36
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Riverside University Health System MISP |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California Commercial |
$135.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$85.36
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Riverside University Health System MISP |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California Commercial |
$135.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$85.36
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Riverside University Health System MISP |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
