|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$1,254.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,030.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,983.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,701.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$4,077.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,054.41 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$2,571.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,704.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,649.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,030.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,332.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,795.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,983.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,087.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,701.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,571.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,391.10
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,509.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,054.41 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$2,571.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,704.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,649.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,030.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,332.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,795.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,983.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,087.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,701.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,571.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,391.10
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,509.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.68
|
| Rate for Payer: Blue Shield of California Commercial |
$75.39
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Riverside University Health System MISP |
$37.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Blue Shield of California Commercial |
$75.39
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
915358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Adventist Health Commercial |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$85.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.90
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$53.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Riverside University Health System MISP |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.95
|
| Rate for Payer: Vantage Medical Group Senior |
$90.95
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
915358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California Commercial |
$85.81
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
|
HC BKV DNA QUANT PCR TEST
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913698
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC BKV DNA QUANT PCR TEST
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913698
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California Commercial |
$28.98
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$228.69
|
| Rate for Payer: Blue Shield of California EPN |
$144.11
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Central Health Plan Commercial |
$290.40
|
| Rate for Payer: Cigna of CA HMO |
$232.32
|
| Rate for Payer: Cigna of CA PPO |
$268.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$326.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$230.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Central Health Plan Commercial |
$290.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$145.20
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$326.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$230.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.60
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$209.16
|
| Rate for Payer: Blue Shield of California Commercial |
$172.62
|
| Rate for Payer: Blue Shield of California EPN |
$131.80
|
| Rate for Payer: Blue Shield of California EPN |
$108.78
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.62 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$896.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$896.84
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Prime Health Services Medicare |
$950.65
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$986.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| 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 |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$408.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| Rate for Payer: Cigna of CA HMO |
$638.08
|
| Rate for Payer: Cigna of CA PPO |
$737.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$897.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$598.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$598.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$897.30 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.80
|
| Rate for Payer: EPIC Health Plan Senior |
$398.80
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$897.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$897.30 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.80
|
| Rate for Payer: EPIC Health Plan Senior |
$398.80
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$897.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Adventist Health Commercial |
$260.40
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,041.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$911.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.80
|
| Rate for Payer: EPIC Health Plan Senior |
$520.80
|
| Rate for Payer: Galaxy Health WC |
$1,106.70
|
| Rate for Payer: Global Benefits Group Commercial |
$781.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,171.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$826.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$768.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: Networks By Design Commercial |
$846.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,106.70
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| Rate for Payer: Cigna of CA HMO |
$638.08
|
| Rate for Payer: Cigna of CA PPO |
$737.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$897.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$598.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.50
|
| Rate for Payer: United Healthcare All Other HMO |
$498.50
|
| Rate for Payer: United Healthcare HMO Rider |
$498.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$498.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$632.10
|
| Rate for Payer: Blue Shield of California EPN |
$397.80
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| Rate for Payer: Cigna of CA HMO |
$638.08
|
| Rate for Payer: Cigna of CA PPO |
$737.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$897.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$598.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$598.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.50
|
| Rate for Payer: United Healthcare All Other HMO |
$498.50
|
| Rate for Payer: United Healthcare HMO Rider |
$498.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$498.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$897.30 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.80
|
| Rate for Payer: EPIC Health Plan Senior |
$398.80
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$897.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$260.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,041.60
|
| Rate for Payer: Cigna of CA HMO |
$833.28
|
| Rate for Payer: Cigna of CA PPO |
$963.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$911.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,106.70
|
| Rate for Payer: Global Benefits Group Commercial |
$781.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,171.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$826.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$846.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,106.70
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$781.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$651.00
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$45.62 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.62
|
| Rate for Payer: Blue Shield of California Commercial |
$211.05
|
| Rate for Payer: Blue Shield of California Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California EPN |
$133.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Senior |
$5.30
|
| Rate for Payer: EPIC Health Plan Senior |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.11
|
| Rate for Payer: Prime Health Services Medicare |
$5.11
|
| Rate for Payer: Riverside University Health System MISP |
$5.30
|
| Rate for Payer: Riverside University Health System MISP |
$5.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
