|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.78
|
| Rate for Payer: BCBS Transplant Transplant |
$1,214.40
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: IEHP medi-cal |
$1,440.62
|
| Rate for Payer: IEHP Medicare Advantage |
$873.10
|
| Rate for Payer: Innovage PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: Riverside University Health MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
944000111
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
944000111
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.78
|
| Rate for Payer: BCBS Transplant Transplant |
$1,214.40
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: IEHP medi-cal |
$1,440.62
|
| Rate for Payer: IEHP Medicare Advantage |
$873.10
|
| Rate for Payer: Innovage PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: Riverside University Health MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000308
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.78
|
| Rate for Payer: BCBS Transplant Transplant |
$1,214.40
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: IEHP medi-cal |
$1,440.62
|
| Rate for Payer: IEHP Medicare Advantage |
$873.10
|
| Rate for Payer: Innovage PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: Riverside University Health MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000308
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC UNSCH EMER DIAL ESRD OP NO CRT
|
Facility
OP
|
$2,808.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
940110257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,394.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,359.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,658.97
|
| Rate for Payer: BCBS Transplant Transplant |
$1,684.80
|
| Rate for Payer: Caremore Medicare Advantage |
$873.10
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$1,797.12
|
| Rate for Payer: Cigna of CA PPO |
$2,077.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,431.88
|
| Rate for Payer: IEHP medi-cal |
$1,440.62
|
| Rate for Payer: IEHP Medicare Advantage |
$873.10
|
| Rate for Payer: Innovage PACE Commercial |
$1,309.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
| Rate for Payer: Prime Health Services Medicare |
$925.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,684.80
|
| Rate for Payer: Riverside University Health MISP |
$960.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,684.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,684.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC UNSCH EMER DIAL ESRD OP NO CRT
|
Facility
IP
|
$2,808.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
940110257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Cash Price |
$1,263.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
|
|
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 |
$52.85 |
| Max. Negotiated Rate |
$286.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$286.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$83.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.21
|
| Rate for Payer: BCBS Transplant Transplant |
$90.60
|
| Rate for Payer: Blue Shield of California Commercial |
$113.25
|
| Rate for Payer: Blue Shield of California EPN |
$82.14
|
| 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: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$113.25
|
| Rate for Payer: IEHP medi-cal |
$52.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.91
|
| 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 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 |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$75.50
|
| Rate for Payer: United Healthcare HMO Rider |
$75.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.50
|
| 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: Blue Shield of California EPN |
$80.63
|
| 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: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$100.72
|
| 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 |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
OP
|
$2,527.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,516.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,021.60
|
| Rate for Payer: Cigna of CA PPO |
$1,869.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,147.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,516.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,274.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,895.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: IEHP medi-cal |
$3,922.79
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Innovage PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,685.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,895.25
|
| Rate for Payer: Networks By Design Commercial |
$1,642.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,147.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Riverside University Health MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,516.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$756.20 |
| Max. Negotiated Rate |
$3,402.90 |
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,024.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,512.40
|
| Rate for Payer: Galaxy Health WC |
$3,213.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,268.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,402.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,521.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.20
|
| Rate for Payer: Multiplan Commercial |
$2,835.75
|
| Rate for Payer: Networks By Design Commercial |
$2,457.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,213.85
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
OP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,285.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,443.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,677.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,380.00
|
| Rate for Payer: Cigna of CA HMO |
$3,504.00
|
| Rate for Payer: Cigna of CA PPO |
$4,051.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,927.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,106.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: IEHP medi-cal |
$1,868.77
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Innovage PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,106.25
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,285.00
|
| Rate for Payer: Riverside University Health MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,285.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,737.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,737.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,737.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
IP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$4,927.50 |
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,380.00
|
| 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: Health Management Network EPO/PPO |
$4,927.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.00
|
| Rate for Payer: Multiplan Commercial |
$4,106.25
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
|
|
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 |
$1,095.00 |
| Max. Negotiated Rate |
$4,927.50 |
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,380.00
|
| 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: Health Management Network EPO/PPO |
$4,927.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.00
|
| Rate for Payer: Multiplan Commercial |
$4,106.25
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
OP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,285.00
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,380.00
|
| Rate for Payer: Cigna of CA PPO |
$4,051.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,927.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,106.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Innovage PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,106.25
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,285.00
|
| Rate for Payer: Riverside University Health MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,737.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,737.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,737.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
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 |
$1,211.40 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,785.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,634.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,785.03
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,845.60
|
| Rate for Payer: Cigna of CA PPO |
$4,482.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| 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 Management Network EPO/PPO |
$5,451.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,542.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,847.45
|
| Rate for Payer: IEHP medi-cal |
$7,895.30
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Innovage PACE Commercial |
$7,177.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,040.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,411.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$4,542.75
|
| Rate for Payer: Networks By Design Commercial |
$3,937.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,148.45
|
| Rate for Payer: Prime Health Services Medicare |
$5,072.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,263.53
|
| Rate for Payer: Riverside University Health MISP |
$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 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 |
$1,812.80 |
| Max. Negotiated Rate |
$8,157.60 |
| Rate for Payer: Cash Price |
$4,078.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,251.20
|
| 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: Health Management Network EPO/PPO |
$8,157.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,045.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,812.80
|
| Rate for Payer: Multiplan Commercial |
$6,798.00
|
| Rate for Payer: Networks By Design Commercial |
$5,891.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,704.40
|
|
|
HC UREA NITROGEN, UR
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| 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 Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.12
|
| Rate for Payer: BCBS Transplant Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| 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: 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 Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: IEHP medi-cal |
$9.17
|
| Rate for Payer: IEHP Medicare Advantage |
$5.56
|
| Rate for Payer: Innovage PACE Commercial |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: Riverside University Health MISP |
$6.12
|
| 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 UREA NITROGEN, UR
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| 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 Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.12
|
| Rate for Payer: BCBS Transplant Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| 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: 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 Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: IEHP medi-cal |
$9.17
|
| Rate for Payer: IEHP Medicare Advantage |
$5.56
|
| Rate for Payer: Innovage PACE Commercial |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: Riverside University Health MISP |
$6.12
|
| 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 UREA NITROGEN URINE 24 HOURS
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| 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 Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.12
|
| Rate for Payer: BCBS Transplant Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| 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: 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 Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: IEHP medi-cal |
$9.17
|
| Rate for Payer: IEHP Medicare Advantage |
$5.56
|
| Rate for Payer: Innovage PACE Commercial |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: Riverside University Health MISP |
$6.12
|
| 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
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$977.20 |
| Max. Negotiated Rate |
$4,397.40 |
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,908.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.40
|
| Rate for Payer: Galaxy Health WC |
$4,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,397.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.20
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
| Rate for Payer: Networks By Design Commercial |
$3,175.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.10
|
|
