|
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
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,113.60
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,752.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,278.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$12,294.00
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,835.20
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,278.40 |
| Max. Negotiated Rate |
$14,752.80 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,752.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,278.40
|
| Rate for Payer: Multiplan Commercial |
$12,294.00
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URE STNT PLCMNT WO NEPH CATH
|
Facility
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
909050694
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,113.60
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,752.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,278.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$12,294.00
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,835.20
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URE STNT PLCMNT WO NEPH CATH
|
Facility
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
909050694
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,278.40 |
| Max. Negotiated Rate |
$14,752.80 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,752.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,278.40
|
| Rate for Payer: Multiplan Commercial |
$12,294.00
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URETERAL BIOPSY
|
Facility
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.00 |
| Max. Negotiated Rate |
$8,671.50 |
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,854.00
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
|
|
HC URETERAL BIOPSY
|
Facility
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,465.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,781.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6,465.01
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: Cigna of CA PPO |
$7,129.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,226.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,602.62
|
| Rate for Payer: IEHP medi-cal |
$10,667.27
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Innovage PACE Commercial |
$9,697.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,663.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
| Rate for Payer: Prime Health Services Medicare |
$6,852.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,781.00
|
| Rate for Payer: Riverside University Health MISP |
$7,111.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,781.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.00 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,781.00
|
| 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 |
$4,355.72
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: Cigna of CA PPO |
$7,129.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,226.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,781.00
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,781.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.00 |
| Max. Negotiated Rate |
$8,671.50 |
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,854.00
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
|
|
HC URETERAL DILATION
|
Facility
OP
|
$10,054.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$9,048.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,032.40
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,043.20
|
| Rate for Payer: Cigna of CA PPO |
$7,439.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$8,545.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,032.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,048.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,540.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Innovage PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$7,540.50
|
| Rate for Payer: Networks By Design Commercial |
$6,535.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,545.90
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,032.40
|
| Rate for Payer: Riverside University Health MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,032.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,027.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,027.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,027.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC URETERAL DILATION
|
Facility
IP
|
$10,054.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,010.80 |
| Max. Negotiated Rate |
$9,048.60 |
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,043.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,021.60
|
| Rate for Payer: Galaxy Health WC |
$8,545.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,032.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,048.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.80
|
| Rate for Payer: Multiplan Commercial |
$7,540.50
|
| Rate for Payer: Networks By Design Commercial |
$6,535.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,545.90
|
|
|
HC URETERAL DILATION
|
Facility
IP
|
$10,054.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.80 |
| Max. Negotiated Rate |
$9,048.60 |
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,043.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,021.60
|
| Rate for Payer: Galaxy Health WC |
$8,545.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,032.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,048.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.80
|
| Rate for Payer: Multiplan Commercial |
$7,540.50
|
| Rate for Payer: Networks By Design Commercial |
$6,535.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,545.90
|
|
|
HC URETERAL DILATION
|
Facility
OP
|
$10,054.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$9,048.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,868.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,939.90
|
| Rate for Payer: BCBS Transplant Transplant |
$6,032.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Cash Price |
$4,524.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,043.20
|
| Rate for Payer: Cigna of CA PPO |
$7,439.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$8,545.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,032.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,048.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,540.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: IEHP medi-cal |
$509.50
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Innovage PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$7,540.50
|
| Rate for Payer: Networks By Design Commercial |
$6,535.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,545.90
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,032.40
|
| Rate for Payer: Riverside University Health MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,032.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC URETERAL STENT KIT
|
Facility
IP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$683.10 |
| Rate for Payer: Blue Shield of California EPN |
$405.31
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Central Health Plan Commercial |
$607.20
|
| Rate for Payer: Cigna of CA HMO |
$531.30
|
| Rate for Payer: Cigna of CA PPO |
$531.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$683.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
|
|
HC URETERAL STENT KIT
|
Facility
OP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$822.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$822.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$417.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$346.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.76
|
| Rate for Payer: BCBS Transplant Transplant |
$455.40
|
| Rate for Payer: Blue Shield of California Commercial |
$569.25
|
| Rate for Payer: Blue Shield of California EPN |
$412.90
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Central Health Plan Commercial |
$607.20
|
| Rate for Payer: Cigna of CA HMO |
$531.30
|
| Rate for Payer: Cigna of CA PPO |
$531.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$683.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$569.25
|
| Rate for Payer: IEHP medi-cal |
$265.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: Networks By Design Commercial |
$379.50
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Riverside University Health MISP |
$303.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.50
|
| Rate for Payer: United Healthcare All Other HMO |
$379.50
|
| Rate for Payer: United Healthcare HMO Rider |
$379.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,113.60
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,752.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,278.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$12,294.00
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,835.20
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,278.40 |
| Max. Negotiated Rate |
$14,752.80 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,752.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,278.40
|
| Rate for Payer: Multiplan Commercial |
$12,294.00
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$300.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$194.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$194.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$212.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$265.50
|
| Rate for Payer: IEHP medi-cal |
$123.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: Riverside University Health MISP |
$141.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.90
|
| Rate for Payer: Vantage Medical Group Senior |
$300.90
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$311.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$340.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Central Health Plan Commercial |
$453.60
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$510.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$425.25
|
| Rate for Payer: IEHP medi-cal |
$198.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$340.20
|
| Rate for Payer: Riverside University Health MISP |
$226.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.95
|
| Rate for Payer: Vantage Medical Group Senior |
$481.95
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$510.30 |
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Central Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$510.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC URIC ACID
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC URIC ACID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.15
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.41
|
| Rate for Payer: IEHP medi-cal |
$7.46
|
| Rate for Payer: IEHP Medicare Advantage |
$4.52
|
| Rate for Payer: Innovage PACE Commercial |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$4.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$4.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3.66
|
| Rate for Payer: United Healthcare HMO Rider |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
HC URIC ACID BODY FLUID
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC URIC ACID BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.08
|
| 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 |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$5.08
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: IEHP medi-cal |
$8.38
|
| Rate for Payer: IEHP Medicare Advantage |
$5.08
|
| Rate for Payer: Innovage PACE Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$5.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
