|
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 |
$62.84
|
| Rate for Payer: Blue Shield of California Commercial |
$82.71
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$58.85
|
| Rate for Payer: Cash Price |
$58.85
|
| 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: 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: InnovAge PACE Commercial |
$53.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
$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 |
$72.66
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$51.70
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| 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
|
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: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Blue Shield of California Commercial |
$82.71
|
| Rate for Payer: Blue Shield of California EPN |
$53.93
|
| Rate for Payer: Cash Price |
$58.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| 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 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 |
$55.21
|
| Rate for Payer: Blue Shield of California Commercial |
$72.66
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| 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: 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: InnovAge PACE Commercial |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$199.65
|
| Rate for Payer: Central Health Plan Commercial |
$290.40
|
| 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 Permanente of CA Commercial/Self Funded |
$242.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.70
|
| 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 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 |
$326.70 |
| 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 |
$220.45
|
| 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 |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$220.34
|
| Rate for Payer: Blue Shield of California EPN |
$144.11
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Cash Price |
$199.65
|
| 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: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| 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: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$246.60 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.40
|
| 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 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 HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$166.32
|
| Rate for Payer: Blue Shield of California EPN |
$108.78
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| 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) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| 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 HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| 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 Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Senior |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
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 |
$602.25
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| 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 Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| 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 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 |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$848.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.09
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| 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 |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| 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 |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| 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 |
$848.09
|
| 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 |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| 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 |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
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 |
$548.35
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| 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 Permanente of CA Commercial/Self Funded |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.14
|
| 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
|
$997.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| 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 |
$482.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.54
|
| Rate for Payer: Blue Shield of California Commercial |
$609.17
|
| Rate for Payer: Blue Shield of California EPN |
$397.80
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| 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 |
$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 |
$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 |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.12
|
| 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 |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| 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 |
$747.75
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| 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 |
$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 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| 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 |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| 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 |
$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 |
$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 |
$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 |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| 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 |
$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 |
$309.02
|
| 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 |
$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 |
$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 |
$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 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 |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$260.40
|
| 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 |
$630.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$764.66
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cash Price |
$716.10
|
| 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 |
$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 |
$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 |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.12
|
| 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 |
$868.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| 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 |
$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 |
$309.02
|
| 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 |
$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 |
$781.20
|
| 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 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 |
$2,901.00 |
| 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 |
$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 |
$585.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Cash Price |
$548.35
|
| 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 |
$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 |
$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 |
$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 |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.40
|
| 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 |
$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 |
$309.02
|
| 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 |
$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 |
$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 |
$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 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 |
$548.35
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| 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 Permanente of CA Commercial/Self Funded |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.14
|
| 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
|
450
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$897.30 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Cash Price |
$548.35
|
| Rate for Payer: Central Health Plan Commercial |
$797.60
|
| 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 Permanente of CA Commercial/Self Funded |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.14
|
| 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 |
$716.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,041.60
|
| 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 Permanente of CA Commercial/Self Funded |
$868.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$805.94
|
| 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 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 |
$32.81 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.72
|
| 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 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 HMO/PPO |
$6.66
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: 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) Medicare Advantage |
$4.82
|
| Rate for Payer: InnovAge PACE Commercial |
$7.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$5.11
|
| Rate for Payer: Riverside University Health System MISP |
$5.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$3.91
|
| 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 Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.40 |
| Max. Negotiated Rate |
$1,558.80 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.80
|
| Rate for Payer: EPIC Health Plan Senior |
$692.80
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$346.40 |
| Max. Negotiated Rate |
$1,558.80 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.80
|
| Rate for Payer: EPIC Health Plan Senior |
$692.80
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| 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 |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| 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 |
$605.18
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: Cigna of CA HMO |
$1,108.48
|
| Rate for Payer: Cigna of CA PPO |
$1,281.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$866.00
|
| Rate for Payer: United Healthcare HMO Rider |
$866.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$710.12
|
| 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 |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,017.20
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Cash Price |
$952.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,385.60
|
| Rate for Payer: Cigna of CA HMO |
$1,108.48
|
| Rate for Payer: Cigna of CA PPO |
$1,281.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$1,472.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,558.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,125.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,472.20
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,039.20
|
| 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 |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$6,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,623.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
