|
HC URETERAL DILATION
|
Facility
|
OP
|
$10,278.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,055.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,351.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,680.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,362.08
|
| Rate for Payer: Heritage Provider Network Senior |
$395.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$610.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,860.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,569.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$7,708.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$353.49
|
| Rate for Payer: TriValley Medical Group Senior |
$353.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$10,278.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,860.32 |
| Max. Negotiated Rate |
$7,708.50 |
| Rate for Payer: Adventist Health Commercial |
$2,055.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.03
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,958.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,860.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,569.50
|
| Rate for Payer: Multiplan Commercial |
$7,708.50
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$10,278.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,055.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,351.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,882.05
|
| Rate for Payer: Blue Shield of California EPN |
$3,885.08
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,680.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,958.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,902.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,860.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,569.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$7,708.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,166.80
|
| Rate for Payer: TriValley Medical Group Senior |
$6,166.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC URETERAL STENT KIT
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.12
|
| Rate for Payer: Blue Shield of California EPN |
$305.12
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.42
|
| Rate for Payer: Heritage Provider Network Senior |
$351.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$379.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.30
|
|
|
HC URETERAL STENT KIT
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.12
|
| Rate for Payer: Blue Shield of California EPN |
$305.12
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.42
|
| Rate for Payer: Heritage Provider Network Senior |
$351.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$379.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$531.30
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
|
OP
|
$9,137.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,653.80 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,827.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,646.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,111.65
|
| Rate for Payer: Cash Price |
$4,111.65
|
| Rate for Payer: Cash Price |
$4,111.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,939.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,655.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,653.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$6,852.75
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC URETER DRAIN OR STENT PLCMNT
|
Facility
|
IP
|
$9,137.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
909000166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,653.80 |
| Max. Negotiated Rate |
$6,852.75 |
| Rate for Payer: Adventist Health Commercial |
$1,827.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,884.23
|
| Rate for Payer: Cash Price |
$4,111.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,185.75
|
| Rate for Payer: Heritage Provider Network Senior |
$6,185.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,653.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.25
|
| Rate for Payer: Multiplan Commercial |
$6,852.75
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.82
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.24
|
| Rate for Payer: Heritage Provider Network Senior |
$234.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
|
|
HC URET'GRAM THRU URET. CATH
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
909000208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$259.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.17
|
| Rate for Payer: Heritage Provider Network Senior |
$214.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$165.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.10
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$382.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.55
|
| Rate for Payer: Heritage Provider Network Senior |
$278.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$214.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$315.00
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.50
|
| Rate for Payer: Vantage Medical Group Senior |
$382.50
|
|
|
HC URETHROCYSTOGRAM,RETROGRADE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
909000172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.80
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
|
|
HC URIC ACID
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.58
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.07
|
| Rate for Payer: Heritage Provider Network Senior |
$92.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
|
|
HC URIC ACID
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
900910254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.35
|
| Rate for Payer: Blue Shield of California Commercial |
$36.35
|
| Rate for Payer: Blue Shield of California EPN |
$29.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.15
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.52
|
| Rate for Payer: TriValley Medical Group Senior |
$4.52
|
| Rate for Payer: TriValley Medical Group Senior |
$4.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.97
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.52
|
|
|
HC URIC ACID BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC URIC ACID BODY FLUID
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC URIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC URIC ACID URINE RANDOM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE RANDOM
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.56
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
906581002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
906581002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.56
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
