|
HC POTASSIUM BODY FLUID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California Commercial |
$17.01
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.90
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Riverside University Health System MISP |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC POTASSIUM POC
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
|
|
HC POTASSIUM POC
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.91
|
| Rate for Payer: Blue Shield of California Commercial |
$57.33
|
| Rate for Payer: Blue Shield of California EPN |
$36.13
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$58.24
|
| Rate for Payer: Cigna of CA PPO |
$67.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.76
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM STOOL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$124.74
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Blue Shield of California EPN |
$78.61
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA HMO |
$126.72
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM STOOL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California Commercial |
$73.71
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Blue Shield of California EPN |
$46.45
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE 24 HOURS
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California Commercial |
$73.71
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Blue Shield of California EPN |
$46.45
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE 24 HOURS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC POTASSIUM URINE RANDOM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC POTASSIUM URINE RANDOM
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.51
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California Commercial |
$73.71
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Blue Shield of California EPN |
$46.45
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.73
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Prime Health Services Medicare |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POUCH DRAINABLE 2 1/2 IN BARRIER & 2 3/4 IN FL
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
CPT A5063
|
| Hospital Charge Code |
901606851
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$1.84
|
| Rate for Payer: Cigna of CA PPO |
$2.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Riverside University Health System MISP |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2.44
|
|
|
HC POUCH DRAINABLE 2 1/2 IN BARRIER & 2 3/4 IN FL
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
CPT A5063
|
| Hospital Charge Code |
901606851
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
|
|
HC POUCH DRAIN SENSURA FLX XXL
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901698204
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$5.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.47
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Central Health Plan Commercial |
$6.95
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Riverside University Health System MISP |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
HC POUCH DRAIN SENSURA FLX XXL
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901698204
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Central Health Plan Commercial |
$6.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
|
|
HC POUCH DRNBL INVISICLOSE 2 1/4"
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901698441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC POUCH DRNBL INVISICLOSE 2 1/4"
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901698441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC POUCH FECAL COLL FLEXISEAL
|
Facility
|
IP
|
$32.47
|
|
| Hospital Charge Code |
901602381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
|
|
HC POUCH FECAL COLL FLEXISEAL
|
Facility
|
OP
|
$32.47
|
|
| Hospital Charge Code |
901602381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.89
|
| Rate for Payer: Blue Shield of California Commercial |
$20.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.96
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: Cigna of CA HMO |
$20.78
|
| Rate for Payer: Cigna of CA PPO |
$24.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.73
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
| Rate for Payer: Riverside University Health System MISP |
$12.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.23
|
| Rate for Payer: United Healthcare All Other HMO |
$16.23
|
| Rate for Payer: United Healthcare HMO Rider |
$16.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.60
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
HC POUCH FECAL COLL MED CUT FIT
|
Facility
|
IP
|
$39.77
|
|
| Hospital Charge Code |
901698388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$31.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.91
|
| Rate for Payer: EPIC Health Plan Senior |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$33.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$29.83
|
| Rate for Payer: Networks By Design Commercial |
$25.85
|
| Rate for Payer: Prime Health Services Commercial |
$33.80
|
|
|
HC POUCH FECAL COLL MED CUT FIT
|
Facility
|
OP
|
$39.77
|
|
| Hospital Charge Code |
901698388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$35.79 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.13
|
| Rate for Payer: Blue Shield of California Commercial |
$25.21
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$31.82
|
| Rate for Payer: Cigna of CA HMO |
$25.45
|
| Rate for Payer: Cigna of CA PPO |
$29.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.91
|
| Rate for Payer: EPIC Health Plan Senior |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$33.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.84
|
| Rate for Payer: Multiplan Commercial |
$29.83
|
| Rate for Payer: Networks By Design Commercial |
$25.85
|
| Rate for Payer: Prime Health Services Commercial |
$33.80
|
| Rate for Payer: Riverside University Health System MISP |
$15.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.89
|
| Rate for Payer: United Healthcare All Other HMO |
$19.89
|
| Rate for Payer: United Healthcare HMO Rider |
$19.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.80
|
| Rate for Payer: Vantage Medical Group Senior |
$33.80
|
|
|
HC POUCH SENSURE TO 3" NON-STRL
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698597
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$36.20 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC POUCH SENSURE TO 3" NON-STRL
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698597
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC POUCH SENSURE UP TO 3" STRL
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$36.20 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
