|
HC URETERAL BRUSH BIOPSY
|
Facility
|
IP
|
$11,347.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,269.40 |
| Max. Negotiated Rate |
$10,212.30 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Cash Price |
$6,240.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,077.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,538.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,538.80
|
| Rate for Payer: Galaxy Health WC |
$9,644.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,212.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,323.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,023.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.40
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
| Rate for Payer: Networks By Design Commercial |
$7,375.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,644.95
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$13,296.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,966.40 |
| Rate for Payer: Adventist Health Commercial |
$2,659.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,636.80
|
| Rate for Payer: Cigna of CA HMO |
$8,509.44
|
| Rate for Payer: Cigna of CA PPO |
$9,839.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$11,301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,977.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,966.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,868.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,659.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$9,972.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$8,642.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$11,301.60
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,977.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,648.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,648.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,648.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,648.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$13,296.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,659.20 |
| Max. Negotiated Rate |
$11,966.40 |
| Rate for Payer: Adventist Health Commercial |
$2,659.20
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,318.40
|
| Rate for Payer: Galaxy Health WC |
$11,301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,977.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,966.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,868.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,065.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,230.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,659.20
|
| Rate for Payer: Multiplan Commercial |
$9,972.00
|
| Rate for Payer: Networks By Design Commercial |
$8,642.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,301.60
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$13,296.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,966.40 |
| Rate for Payer: Adventist Health Commercial |
$2,659.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$309.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,636.80
|
| Rate for Payer: Cigna of CA HMO |
$8,509.44
|
| Rate for Payer: Cigna of CA PPO |
$9,839.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$11,301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,977.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,966.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,868.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,659.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$9,972.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$8,642.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$11,301.60
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,977.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$13,296.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,659.20 |
| Max. Negotiated Rate |
$11,966.40 |
| Rate for Payer: Adventist Health Commercial |
$2,659.20
|
| Rate for Payer: Cash Price |
$7,312.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,636.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,318.40
|
| Rate for Payer: Galaxy Health WC |
$11,301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,977.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,966.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,868.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,065.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,230.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,659.20
|
| Rate for Payer: Multiplan Commercial |
$9,972.00
|
| Rate for Payer: Networks By Design Commercial |
$8,642.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,301.60
|
|
|
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 |
$683.10 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$346.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.26
|
| Rate for Payer: Blue Shield of California Commercial |
$586.71
|
| Rate for Payer: Blue Shield of California EPN |
$382.54
|
| Rate for Payer: Cash Price |
$417.45
|
| 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: Dignity Health Medi-Cal |
$645.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$683.10
|
| Rate for Payer: InnovAge PACE Commercial |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.30
|
| Rate for Payer: Multiplan Commercial |
$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 System 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 |
$284.85
|
| Rate for Payer: United Healthcare All Other HMO |
$277.26
|
| Rate for Payer: United Healthcare HMO Rider |
$271.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC 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: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Blue Shield of California Commercial |
$586.71
|
| Rate for Payer: Blue Shield of California EPN |
$382.54
|
| Rate for Payer: Cash Price |
$417.45
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| 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: United Healthcare All Other Commercial |
$284.85
|
| Rate for Payer: United Healthcare All Other HMO |
$277.26
|
| Rate for Payer: United Healthcare HMO Rider |
$271.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.57
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
|
OP
|
$21,679.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,675.18 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$4,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,382.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$11,923.45
|
| Rate for Payer: Cash Price |
$11,923.45
|
| Rate for Payer: Cash Price |
$11,923.45
|
| Rate for Payer: Central Health Plan Commercial |
$17,343.20
|
| Rate for Payer: Cigna of CA HMO |
$13,874.56
|
| Rate for Payer: Cigna of CA PPO |
$16,042.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$18,427.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,573.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,459.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,850.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,872.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$16,259.25
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$14,091.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$18,427.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,645.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,820.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
|
IP
|
$21,679.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,335.80 |
| Max. Negotiated Rate |
$19,511.10 |
| Rate for Payer: Adventist Health Commercial |
$4,335.80
|
| Rate for Payer: Cash Price |
$11,923.45
|
| Rate for Payer: Central Health Plan Commercial |
$17,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,671.60
|
| Rate for Payer: Galaxy Health WC |
$18,427.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,511.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,459.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,259.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,419.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,335.80
|
| Rate for Payer: Multiplan Commercial |
$16,259.25
|
| Rate for Payer: Networks By Design Commercial |
$14,091.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,427.15
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$259.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$167.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Central Health Plan Commercial |
$276.80
|
| Rate for Payer: Cigna of CA HMO |
$221.44
|
| Rate for Payer: Cigna of CA PPO |
$256.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$138.40
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$311.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$434.16
|
| Rate for Payer: InnovAge PACE Commercial |
$173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
| Rate for Payer: Riverside University Health System MISP |
$138.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.10
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Central Health Plan Commercial |
$276.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$138.40
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$311.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.20
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Central Health Plan Commercial |
$443.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$498.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.80
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Central Health Plan Commercial |
$443.20
|
| Rate for Payer: Cigna of CA HMO |
$354.56
|
| Rate for Payer: Cigna of CA PPO |
$409.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$498.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$473.22
|
| Rate for Payer: InnovAge PACE Commercial |
$277.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.80
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
| Rate for Payer: Riverside University Health System MISP |
$221.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$332.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC URIC ACID
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Alpha Care Medical Group 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 |
$6.68
|
| Rate for Payer: Blue Shield of California Commercial |
$29.14
|
| Rate for Payer: Blue Shield of California EPN |
$19.06
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.52
|
| Rate for Payer: InnovAge PACE Commercial |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| 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 |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Medicare |
$4.79
|
| Rate for Payer: Riverside University Health System MISP |
$4.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.66
|
| Rate for Payer: United Healthcare All Other 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: Upland Medical Group Pediatric |
$4.52
|
| 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
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC URIC ACID BODY FLUID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group 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 |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$16.39
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: InnovAge PACE Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| 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 |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$5.38
|
| Rate for Payer: Riverside University Health System MISP |
$5.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| 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: Upland Medical Group Pediatric |
$5.08
|
| 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
|
|
|
HC URIC ACID BODY FLUID
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
|
|
HC URIC ACID URINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC URIC ACID URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group 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 |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: InnovAge PACE Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.08
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$5.38
|
| Rate for Payer: Riverside University Health System MISP |
$5.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other 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: Upland Medical Group Pediatric |
$5.08
|
| 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
|
|
|
HC URIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC URIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group 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 |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: InnovAge PACE Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.08
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$5.38
|
| Rate for Payer: Riverside University Health System MISP |
$5.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other 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: Upland Medical Group Pediatric |
$5.08
|
| 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
|
|
|
HC URIC ACID URINE RANDOM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC URIC ACID URINE RANDOM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$34.53 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group 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 |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: InnovAge PACE Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.08
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$5.38
|
| Rate for Payer: Riverside University Health System MISP |
$5.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Other 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: Upland Medical Group Pediatric |
$5.08
|
| 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
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
906581002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
