|
HC BRUSH CYTOLOGY OLYMPUS PEDS 1.2MM
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT Z7610
|
| Hospital Charge Code |
900831826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
OP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$516.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$704.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$454.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.37
|
| Rate for Payer: Blue Shield of California Commercial |
$595.50
|
| Rate for Payer: Blue Shield of California EPN |
$374.77
|
| Rate for Payer: Cash Price |
$422.67
|
| Rate for Payer: Cash Price |
$422.67
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: Cigna of CA HMO |
$601.13
|
| Rate for Payer: Cigna of CA PPO |
$695.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$798.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$657.49
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
| Rate for Payer: Riverside University Health System MISP |
$375.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$563.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.63
|
| Rate for Payer: United Healthcare All Other HMO |
$469.63
|
| Rate for Payer: United Healthcare HMO Rider |
$469.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.38
|
| Rate for Payer: Vantage Medical Group Senior |
$798.38
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
IP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Cash Price |
$422.67
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
IP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Cash Price |
$422.67
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
OP
|
$939.27
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$845.34 |
| Rate for Payer: Adventist Health Commercial |
$187.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$516.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$704.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$454.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.37
|
| Rate for Payer: Blue Shield of California Commercial |
$595.50
|
| Rate for Payer: Blue Shield of California EPN |
$374.77
|
| Rate for Payer: Cash Price |
$422.67
|
| Rate for Payer: Cash Price |
$422.67
|
| Rate for Payer: Central Health Plan Commercial |
$751.42
|
| Rate for Payer: Cigna of CA HMO |
$601.13
|
| Rate for Payer: Cigna of CA PPO |
$695.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$798.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.71
|
| Rate for Payer: EPIC Health Plan Senior |
$375.71
|
| Rate for Payer: Galaxy Health WC |
$798.38
|
| Rate for Payer: Global Benefits Group Commercial |
$563.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$657.49
|
| Rate for Payer: Multiplan Commercial |
$704.45
|
| Rate for Payer: Networks By Design Commercial |
$610.53
|
| Rate for Payer: Prime Health Services Commercial |
$798.38
|
| Rate for Payer: Riverside University Health System MISP |
$375.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$563.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.63
|
| Rate for Payer: United Healthcare All Other HMO |
$469.63
|
| Rate for Payer: United Healthcare HMO Rider |
$469.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$798.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.38
|
| Rate for Payer: Vantage Medical Group Senior |
$798.38
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
OP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.66
|
| Rate for Payer: Blue Shield of California Commercial |
$156.57
|
| Rate for Payer: Blue Shield of California EPN |
$98.54
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Central Health Plan Commercial |
$197.57
|
| Rate for Payer: Cigna of CA HMO |
$158.05
|
| Rate for Payer: Cigna of CA PPO |
$182.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.87
|
| Rate for Payer: Multiplan Commercial |
$185.22
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
| Rate for Payer: Riverside University Health System MISP |
$98.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.48
|
| Rate for Payer: United Healthcare HMO Rider |
$123.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.92
|
| Rate for Payer: Vantage Medical Group Senior |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
IP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$222.26 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Central Health Plan Commercial |
$197.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.39
|
| Rate for Payer: Multiplan Commercial |
$185.22
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
IP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$579.11 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Central Health Plan Commercial |
$514.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.69
|
| Rate for Payer: Multiplan Commercial |
$482.59
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
OP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$579.11 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.29
|
| Rate for Payer: Blue Shield of California Commercial |
$407.95
|
| Rate for Payer: Blue Shield of California EPN |
$256.74
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Central Health Plan Commercial |
$514.76
|
| Rate for Payer: Cigna of CA HMO |
$411.81
|
| Rate for Payer: Cigna of CA PPO |
$476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$546.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$450.42
|
| Rate for Payer: Multiplan Commercial |
$482.59
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
| Rate for Payer: Riverside University Health System MISP |
$257.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.73
|
| Rate for Payer: United Healthcare All Other HMO |
$321.73
|
| Rate for Payer: United Healthcare HMO Rider |
$321.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.93
|
| Rate for Payer: Vantage Medical Group Senior |
$546.93
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
OP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$461.34 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$384.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.18
|
| Rate for Payer: Blue Shield of California Commercial |
$324.99
|
| Rate for Payer: Blue Shield of California EPN |
$204.53
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Central Health Plan Commercial |
$410.08
|
| Rate for Payer: Cigna of CA HMO |
$328.06
|
| Rate for Payer: Cigna of CA PPO |
$379.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$384.45
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
| Rate for Payer: Riverside University Health System MISP |
$205.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.30
|
| Rate for Payer: United Healthcare All Other HMO |
$256.30
|
| Rate for Payer: United Healthcare HMO Rider |
$256.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.71
|
| Rate for Payer: Vantage Medical Group Senior |
$435.71
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
IP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$461.34 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Central Health Plan Commercial |
$410.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$358.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$461.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$325.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$302.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.52
|
| Rate for Payer: Multiplan Commercial |
$384.45
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$37.59 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.59
|
| Rate for Payer: Blue Shield of California Commercial |
$166.95
|
| Rate for Payer: Blue Shield of California Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California EPN |
$105.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.37
|
| Rate for Payer: EPIC Health Plan Senior |
$5.58
|
| Rate for Payer: EPIC Health Plan Senior |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.07
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.37
|
| Rate for Payer: Prime Health Services Medicare |
$5.37
|
| Rate for Payer: Riverside University Health System MISP |
$5.58
|
| Rate for Payer: Riverside University Health System MISP |
$5.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
IP
|
$44.77
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$40.29 |
| Rate for Payer: Adventist Health Commercial |
$8.95
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Central Health Plan Commercial |
$35.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.91
|
| Rate for Payer: EPIC Health Plan Senior |
$17.91
|
| Rate for Payer: Galaxy Health WC |
$38.05
|
| Rate for Payer: Global Benefits Group Commercial |
$26.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$33.58
|
| Rate for Payer: Networks By Design Commercial |
$29.10
|
| Rate for Payer: Prime Health Services Commercial |
$38.05
|
|
|
HC BULB RESERVOIR JACKSON PRATT
|
Facility
|
OP
|
$44.77
|
|
| Hospital Charge Code |
901604267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$40.29 |
| Rate for Payer: Adventist Health Commercial |
$8.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.04
|
| Rate for Payer: Blue Shield of California Commercial |
$28.38
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Central Health Plan Commercial |
$35.82
|
| Rate for Payer: Cigna of CA HMO |
$28.65
|
| Rate for Payer: Cigna of CA PPO |
$33.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.91
|
| Rate for Payer: EPIC Health Plan Senior |
$17.91
|
| Rate for Payer: Galaxy Health WC |
$38.05
|
| Rate for Payer: Global Benefits Group Commercial |
$26.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.34
|
| Rate for Payer: Multiplan Commercial |
$33.58
|
| Rate for Payer: Networks By Design Commercial |
$29.10
|
| Rate for Payer: Prime Health Services Commercial |
$38.05
|
| Rate for Payer: Riverside University Health System MISP |
$17.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$22.39
|
| Rate for Payer: United Healthcare HMO Rider |
$22.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.05
|
| Rate for Payer: Vantage Medical Group Senior |
$38.05
|
|
|
HC BUN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC BUN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.90
|
| Rate for Payer: Blue Shield of California Commercial |
$61.74
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.90
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC BUN INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910492
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.34
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910492
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
