|
HC RENAL BIOP PERCUT BY NEEDLE
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
903800069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$198.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA PPO |
$244.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$247.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
IP
|
$4,891.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$978.20 |
| Max. Negotiated Rate |
$4,401.90 |
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.40
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,401.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.20
|
| Rate for Payer: Multiplan Commercial |
$3,668.25
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
OP
|
$4,891.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$978.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,934.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,912.80
|
| Rate for Payer: Cigna of CA PPO |
$3,619.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,401.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,668.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,668.25
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,934.60
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
IP
|
$3,341.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$3,006.90 |
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.40
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,006.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.20
|
| Rate for Payer: Multiplan Commercial |
$2,505.75
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
OP
|
$3,341.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,004.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,672.80
|
| Rate for Payer: Cigna of CA PPO |
$2,472.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,006.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,505.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: IEHP medi-cal |
$1,450.47
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Innovage PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,505.75
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,004.60
|
| Rate for Payer: Riverside University Health MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,004.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,292.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,292.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$260.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.94
|
| Rate for Payer: BCBS Transplant Transplant |
$769.20
|
| Rate for Payer: Blue Shield of California Commercial |
$792.28
|
| Rate for Payer: Blue Shield of California EPN |
$623.05
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA HMO |
$820.48
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$961.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: IEHP medi-cal |
$1,137.31
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Innovage PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$769.20
|
| Rate for Payer: Riverside University Health MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC RENAL DILATOR SET
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Blue Shield of California EPN |
$381.28
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Central Health Plan Commercial |
$571.20
|
| Rate for Payer: Cigna of CA HMO |
$499.80
|
| Rate for Payer: Cigna of CA PPO |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$285.60
|
| Rate for Payer: Galaxy Health WC |
$606.90
|
| Rate for Payer: Global Benefits Group Commercial |
$428.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$642.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: Prime Health Services Commercial |
$606.90
|
|
|
HC RENAL DILATOR SET
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.70
|
| Rate for Payer: BCBS Transplant Transplant |
$428.40
|
| Rate for Payer: Blue Shield of California Commercial |
$535.50
|
| Rate for Payer: Blue Shield of California EPN |
$388.42
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Central Health Plan Commercial |
$571.20
|
| Rate for Payer: Cigna of CA HMO |
$499.80
|
| Rate for Payer: Cigna of CA PPO |
$499.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$285.60
|
| Rate for Payer: Galaxy Health WC |
$606.90
|
| Rate for Payer: Global Benefits Group Commercial |
$428.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$642.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$535.50
|
| Rate for Payer: IEHP medi-cal |
$249.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: Networks By Design Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Commercial |
$606.90
|
| Rate for Payer: Riverside University Health MISP |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$428.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$428.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other HMO |
$357.00
|
| Rate for Payer: United Healthcare HMO Rider |
$357.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.00
|
| Rate for Payer: BCBS Transplant Transplant |
$360.00
|
| Rate for Payer: Blue Shield of California Commercial |
$370.80
|
| Rate for Payer: Blue Shield of California EPN |
$291.60
|
| Rate for Payer: Caremore Medicare Advantage |
$8.68
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Central Health Plan Commercial |
$480.00
|
| Rate for Payer: Cigna of CA HMO |
$384.00
|
| Rate for Payer: Cigna of CA PPO |
$444.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$450.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.24
|
| Rate for Payer: IEHP medi-cal |
$14.32
|
| Rate for Payer: IEHP Medicare Advantage |
$8.68
|
| Rate for Payer: Innovage PACE Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.63
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Prime Health Services Medicare |
$9.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$360.00
|
| Rate for Payer: Riverside University Health MISP |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO |
$7.03
|
| Rate for Payer: United Healthcare HMO Rider |
$7.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
IP
|
$600.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Central Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,728.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,184.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,912.80
|
| Rate for Payer: Cigna of CA PPO |
$6,394.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,776.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,480.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,184.60
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,184.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,728.20 |
| Max. Negotiated Rate |
$7,776.90 |
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,456.40
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,776.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.20
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,728.20 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,184.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,912.80
|
| Rate for Payer: Cigna of CA PPO |
$6,394.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,776.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,480.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,184.60
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,184.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,728.20 |
| Max. Negotiated Rate |
$7,776.90 |
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,456.40
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,776.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.20
|
| Rate for Payer: Multiplan Commercial |
$6,480.75
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,815.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,260.00
|
| Rate for Payer: Cigna of CA PPO |
$6,715.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,167.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,806.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,445.00
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,815.00 |
| Max. Negotiated Rate |
$8,167.50 |
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.00
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,167.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.00
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,815.00 |
| Max. Negotiated Rate |
$8,167.50 |
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.00
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,167.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.00
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,815.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,260.00
|
| Rate for Payer: Cigna of CA PPO |
$6,715.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,167.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,806.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,806.25
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,445.00
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
IP
|
$423.86
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$381.47 |
| Rate for Payer: Cash Price |
$190.74
|
| Rate for Payer: Central Health Plan Commercial |
$339.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.54
|
| Rate for Payer: Galaxy Health WC |
$360.28
|
| Rate for Payer: Global Benefits Group Commercial |
$254.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.77
|
| Rate for Payer: Multiplan Commercial |
$317.90
|
| Rate for Payer: Networks By Design Commercial |
$275.51
|
| Rate for Payer: Prime Health Services Commercial |
$360.28
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
OP
|
$423.86
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$381.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$360.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$233.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$233.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$205.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.42
|
| Rate for Payer: BCBS Transplant Transplant |
$254.32
|
| Rate for Payer: Blue Shield of California Commercial |
$266.61
|
| Rate for Payer: Blue Shield of California EPN |
$207.27
|
| Rate for Payer: Cash Price |
$190.74
|
| Rate for Payer: Cash Price |
$190.74
|
| Rate for Payer: Central Health Plan Commercial |
$339.09
|
| Rate for Payer: Cigna of CA HMO |
$271.27
|
| Rate for Payer: Cigna of CA PPO |
$313.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$360.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.54
|
| Rate for Payer: Galaxy Health WC |
$360.28
|
| Rate for Payer: Global Benefits Group Commercial |
$254.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$317.90
|
| Rate for Payer: IEHP medi-cal |
$148.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.77
|
| Rate for Payer: Multiplan Commercial |
$317.90
|
| Rate for Payer: Networks By Design Commercial |
$275.51
|
| Rate for Payer: Prime Health Services Commercial |
$360.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$254.32
|
| Rate for Payer: Riverside University Health MISP |
$169.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.93
|
| Rate for Payer: United Healthcare All Other HMO |
$211.93
|
| Rate for Payer: United Healthcare HMO Rider |
$211.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$360.28
|
| Rate for Payer: Vantage Medical Group Senior |
$360.28
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
OP
|
$3,890.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$675.33 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,070.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$923.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,298.21
|
| Rate for Payer: BCBS Transplant Transplant |
$2,334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,404.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,890.54
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: Cigna of CA HMO |
$2,489.60
|
| Rate for Payer: Cigna of CA PPO |
$2,878.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,917.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: IEHP medi-cal |
$1,114.29
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,594.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,334.00
|
| Rate for Payer: Riverside University Health MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,334.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,334.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
IP
|
$3,890.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$778.00 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.00
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,594.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
|
|
HC REPAIR ANAL FISTULA
|
Facility
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 46288
|
| Hospital Charge Code |
904000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,073.00 |
| Max. Negotiated Rate |
$4,828.50 |
| Rate for Payer: Cash Price |
$2,414.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,292.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,146.00
|
| Rate for Payer: Galaxy Health WC |
$4,560.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,828.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,578.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,073.00
|
| Rate for Payer: Multiplan Commercial |
$4,023.75
|
| Rate for Payer: Networks By Design Commercial |
$3,487.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,560.25
|
|
|
HC REPAIR ANAL FISTULA
|
Facility
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 46288
|
| Hospital Charge Code |
904000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,073.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,508.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,219.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,374.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,623.48
|
| Rate for Payer: Caremore Medicare Advantage |
$3,508.15
|
| Rate for Payer: Cash Price |
$2,414.25
|
| Rate for Payer: Cash Price |
$2,414.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,292.00
|
| Rate for Payer: Cigna of CA HMO |
$3,433.60
|
| Rate for Payer: Cigna of CA PPO |
$3,970.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$4,560.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,828.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,023.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,753.37
|
| Rate for Payer: IEHP medi-cal |
$5,788.45
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Innovage PACE Commercial |
$5,262.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,578.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,073.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,700.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$4,023.75
|
| Rate for Payer: Networks By Design Commercial |
$3,487.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,560.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,718.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,219.00
|
| Rate for Payer: Riverside University Health MISP |
$3,858.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,682.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,682.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,682.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,682.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
