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Charge Type Setting Price  
Service Code CPT G0176
Hospital Charge Code 907804016
Hospital Revenue Code 904
Min. Negotiated Rate $125.40
Max. Negotiated Rate $171.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $136.80
Rate for Payer: Aetna of CA Government/Medicare $136.80
Rate for Payer: Cash Price $102.60
Rate for Payer: Health Smart Auto/Commercial $136.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $136.80
Rate for Payer: LLUH Dept of Risk Management WC $125.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS $171.00
Service Code CPT G0176
Hospital Charge Code 907804016
Hospital Revenue Code 904
Min. Negotiated Rate $125.40
Max. Negotiated Rate $182.40
Rate for Payer: Cash Price $102.60
Rate for Payer: Cigna of CA HMO/PPO $182.40
Rate for Payer: Health Smart Auto/Commercial $136.80
Rate for Payer: LLUH Dept of Risk Management WC $125.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS $171.00
Service Code CPT 90834
Hospital Charge Code 907804016
Hospital Revenue Code 904
Min. Negotiated Rate $125.40
Max. Negotiated Rate $171.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $149.60
Rate for Payer: Aetna of CA Government/Medicare $149.60
Rate for Payer: Cash Price $102.60
Rate for Payer: Cash Price $102.60
Rate for Payer: Health Smart Auto/Commercial $136.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $136.80
Rate for Payer: LLUH Dept of Risk Management WC $125.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS $171.00
Service Code CPT 90834
Hospital Charge Code 907804016
Hospital Revenue Code 912
Min. Negotiated Rate $125.40
Max. Negotiated Rate $725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $725.00
Rate for Payer: Aetna of CA Government/Medicare $149.60
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage $600.00
Rate for Payer: Blue Shield of California Commercial $569.00
Rate for Payer: Cash Price $102.60
Rate for Payer: Cash Price $102.60
Rate for Payer: Cash Price $102.60
Rate for Payer: Cigna of CA HMO/PPO $594.00
Rate for Payer: Health Smart Auto/Commercial $616.00
Rate for Payer: Heritage Provider Network Commercial $472.00
Rate for Payer: Heritage Provider Network Senior $472.00
Rate for Payer: Intervalley Health Plan Commercial $720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $522.00
Rate for Payer: LLUH Dept of Risk Management WC $125.40
Rate for Payer: Magellan Commercial $637.00
Rate for Payer: Managed Health Network (MHN) Commercial $682.00
Rate for Payer: Managed Health Network (MHN) Medicare $199.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS $171.00
Rate for Payer: US Behavioral Health Commercial/Medicare $498.68
Service Code CPT 90834
Hospital Charge Code 907804016
Hospital Revenue Code 904
Min. Negotiated Rate $125.40
Max. Negotiated Rate $182.40
Rate for Payer: Cash Price $102.60
Rate for Payer: Cigna of CA HMO/PPO $182.40
Rate for Payer: Health Smart Auto/Commercial $136.80
Rate for Payer: LLUH Dept of Risk Management WC $125.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS $171.00
Service Code CPT 90834
Hospital Charge Code 907804016
Hospital Revenue Code 912
Min. Negotiated Rate $125.40
Max. Negotiated Rate $644.00
Rate for Payer: Cash Price $102.60
Rate for Payer: Cash Price $102.60
Rate for Payer: Cigna of CA HMO/PPO $182.40
Rate for Payer: Health Smart Auto/Commercial $136.80
Rate for Payer: LLUH Dept of Risk Management WC $125.40
Rate for Payer: Mary Free Bed Workers' Compensation $644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $171.00
Service Code CPT 90853
Hospital Charge Code 907804035
Hospital Revenue Code 912
Min. Negotiated Rate $178.75
Max. Negotiated Rate $644.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $260.00
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Mary Free Bed Workers' Compensation $644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 90853
Hospital Charge Code 907804035
Hospital Revenue Code 942
Min. Negotiated Rate $178.75
Max. Negotiated Rate $260.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $260.00
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT G0177
Hospital Charge Code 907804035
Hospital Revenue Code 942
Min. Negotiated Rate $178.75
Max. Negotiated Rate $243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $195.00
Rate for Payer: Aetna of CA Government/Medicare $195.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 90853
Hospital Charge Code 907804035
Hospital Revenue Code 912
Min. Negotiated Rate $41.00
Max. Negotiated Rate $725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $725.00
Rate for Payer: Aetna of CA Government/Medicare $55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage $600.00
Rate for Payer: Blue Shield of California Commercial $569.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $594.00
Rate for Payer: Health Smart Auto/Commercial $616.00
Rate for Payer: Heritage Provider Network Commercial $472.00
Rate for Payer: Heritage Provider Network Senior $472.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage $463.00
Rate for Payer: Intervalley Health Plan Commercial $720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $522.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Magellan Commercial $637.00
Rate for Payer: Managed Health Network (MHN) Commercial $682.00
Rate for Payer: Managed Health Network (MHN) Medicare $111.37
Rate for Payer: Mary Free Bed Workers' Compensation $41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Rate for Payer: US Behavioral Health Commercial/Medicare $498.68
Service Code CPT G0177
Hospital Charge Code 907804035
Hospital Revenue Code 942
Min. Negotiated Rate $178.75
Max. Negotiated Rate $260.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $260.00
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 90853
Hospital Charge Code 907804035
Hospital Revenue Code 942
Min. Negotiated Rate $41.00
Max. Negotiated Rate $243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $55.76
Rate for Payer: Aetna of CA Government/Medicare $55.76
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Mary Free Bed Workers' Compensation $41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT G0176
Hospital Charge Code 907804015
Hospital Revenue Code 904
Min. Negotiated Rate $178.75
Max. Negotiated Rate $260.00
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $260.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 90853
Hospital Charge Code 907804015
Hospital Revenue Code 912
Min. Negotiated Rate $178.75
Max. Negotiated Rate $644.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $260.00
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Mary Free Bed Workers' Compensation $644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 90853
Hospital Charge Code 907804015
Hospital Revenue Code 904
Min. Negotiated Rate $178.75
Max. Negotiated Rate $260.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $260.00
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 90853
Hospital Charge Code 907804015
Hospital Revenue Code 912
Min. Negotiated Rate $41.00
Max. Negotiated Rate $725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $725.00
Rate for Payer: Aetna of CA Government/Medicare $55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage $600.00
Rate for Payer: Blue Shield of California Commercial $569.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Cigna of CA HMO/PPO $594.00
Rate for Payer: Health Smart Auto/Commercial $616.00
Rate for Payer: Heritage Provider Network Commercial $472.00
Rate for Payer: Heritage Provider Network Senior $472.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage $463.00
Rate for Payer: Intervalley Health Plan Commercial $720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $522.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Magellan Commercial $637.00
Rate for Payer: Managed Health Network (MHN) Commercial $682.00
Rate for Payer: Managed Health Network (MHN) Medicare $111.37
Rate for Payer: Mary Free Bed Workers' Compensation $41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Rate for Payer: US Behavioral Health Commercial/Medicare $498.68
Service Code CPT 90853
Hospital Charge Code 907804015
Hospital Revenue Code 904
Min. Negotiated Rate $41.00
Max. Negotiated Rate $243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $55.76
Rate for Payer: Aetna of CA Government/Medicare $55.76
Rate for Payer: Cash Price $146.25
Rate for Payer: Cash Price $146.25
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Mary Free Bed Workers' Compensation $41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT G0176
Hospital Charge Code 907804015
Hospital Revenue Code 904
Min. Negotiated Rate $178.75
Max. Negotiated Rate $243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $195.00
Rate for Payer: Aetna of CA Government/Medicare $195.00
Rate for Payer: Cash Price $146.25
Rate for Payer: Health Smart Auto/Commercial $195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $195.00
Rate for Payer: LLUH Dept of Risk Management WC $178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS $243.75
Service Code CPT 89230
Hospital Charge Code 900910257
Hospital Revenue Code 300
Min. Negotiated Rate $17.05
Max. Negotiated Rate $23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $18.60
Rate for Payer: Aetna of CA Government/Medicare $18.60
Rate for Payer: Cash Price $13.95
Rate for Payer: Health Smart Auto/Commercial $18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $18.60
Rate for Payer: LLUH Dept of Risk Management WC $17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS $23.25
Service Code CPT 89230
Hospital Charge Code 900910257
Hospital Revenue Code 300
Min. Negotiated Rate $177.10
Max. Negotiated Rate $257.60
Rate for Payer: Cash Price $144.90
Rate for Payer: Cigna of CA HMO/PPO $257.60
Rate for Payer: Health Smart Auto/Commercial $193.20
Rate for Payer: LLUH Dept of Risk Management WC $177.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS $241.50
Service Code CPT 82438
Hospital Charge Code 900910680
Hospital Revenue Code 301
Min. Negotiated Rate $102.30
Max. Negotiated Rate $148.80
Rate for Payer: Cash Price $83.70
Rate for Payer: Cigna of CA HMO/PPO $148.80
Rate for Payer: Health Smart Auto/Commercial $111.60
Rate for Payer: LLUH Dept of Risk Management WC $102.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS $139.50
Service Code CPT 82438
Hospital Charge Code 900910680
Hospital Revenue Code 301
Min. Negotiated Rate $10.45
Max. Negotiated Rate $14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $11.40
Rate for Payer: Aetna of CA Government/Medicare $11.40
Rate for Payer: Cash Price $8.55
Rate for Payer: Health Smart Auto/Commercial $11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $11.40
Rate for Payer: LLUH Dept of Risk Management WC $10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS $14.25
Service Code CPT 87181
Hospital Charge Code 900912447
Hospital Revenue Code 306
Min. Negotiated Rate $5.50
Max. Negotiated Rate $7.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $6.00
Rate for Payer: Aetna of CA Government/Medicare $6.00
Rate for Payer: Cash Price $4.50
Rate for Payer: Health Smart Auto/Commercial $6.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $6.00
Rate for Payer: LLUH Dept of Risk Management WC $5.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS $7.50
Service Code CPT 87181
Hospital Charge Code 900912447
Hospital Revenue Code 306
Min. Negotiated Rate $47.85
Max. Negotiated Rate $69.60
Rate for Payer: Cash Price $39.15
Rate for Payer: Cigna of CA HMO/PPO $69.60
Rate for Payer: Health Smart Auto/Commercial $52.20
Rate for Payer: LLUH Dept of Risk Management WC $47.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS $65.25
Service Code CPT 86592
Hospital Charge Code 900913673
Hospital Revenue Code 302
Min. Negotiated Rate $21.45
Max. Negotiated Rate $29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO $23.40
Rate for Payer: Aetna of CA Government/Medicare $23.40
Rate for Payer: Cash Price $17.55
Rate for Payer: Health Smart Auto/Commercial $23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage $23.40
Rate for Payer: LLUH Dept of Risk Management WC $21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS $29.25