|
HC BE MOLD SKT MUENSTER SUSPENSN
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
CPT L6110
|
| Hospital Charge Code |
915356110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$3,973.75 |
| Rate for Payer: Adventist Health Commercial |
$1,916.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,973.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,571.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,506.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,707.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,450.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.05
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cigna of CA HMO |
$3,272.50
|
| Rate for Payer: Cigna of CA PPO |
$3,272.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,973.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,973.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,973.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,870.00
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,433.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,620.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,893.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,272.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,272.50
|
| Rate for Payer: Multiplan Commercial |
$3,740.00
|
| Rate for Payer: Networks By Design Commercial |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,805.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,754.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1,707.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,670.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,531.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,973.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,973.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,973.75
|
|
|
HC BE MOLD SKT MUENSTER SUSPENSN
|
Facility
|
IP
|
$4,675.00
|
|
|
Service Code
|
CPT L6110
|
| Hospital Charge Code |
915356110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$935.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cigna of CA HMO |
$3,272.50
|
| Rate for Payer: Cigna of CA PPO |
$3,272.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,870.00
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,893.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,740.00
|
| Rate for Payer: Networks By Design Commercial |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,754.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1,707.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,670.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,531.06
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.22
|
| Rate for Payer: Blue Shield of California Commercial |
$173.27
|
| Rate for Payer: Blue Shield of California EPN |
$114.48
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC BE SPLIT SKT STEPUP HNG 1/2 CF
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT L6120
|
| Hospital Charge Code |
915356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,461.20
|
| Rate for Payer: Cigna of CA PPO |
$2,461.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,176.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,758.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,256.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,151.49
|
|
|
HC BE SPLIT SKT STEPUP HNG 1/2 CF
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT L6120
|
| Hospital Charge Code |
905356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$843.84 |
| Max. Negotiated Rate |
$2,988.60 |
| Rate for Payer: Adventist Health Commercial |
$1,441.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,988.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,933.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,637.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,036.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,594.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,708.78
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,461.20
|
| Rate for Payer: Cigna of CA PPO |
$2,461.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,988.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,988.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,988.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,658.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,875.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,176.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,461.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,461.20
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,758.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,109.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,256.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,151.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,988.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,988.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,988.60
|
|
|
HC BE SPLIT SKT STEPUP HNG 1/2 CF
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT L6120
|
| Hospital Charge Code |
905356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,461.20
|
| Rate for Payer: Cigna of CA PPO |
$2,461.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,176.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,758.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,256.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,151.49
|
|
|
HC BE SPLIT SKT STEPUP HNG 1/2 CF
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT L6120
|
| Hospital Charge Code |
915356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$843.84 |
| Max. Negotiated Rate |
$2,988.60 |
| Rate for Payer: Adventist Health Commercial |
$1,441.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,988.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,933.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,637.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,036.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,594.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,708.78
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,461.20
|
| Rate for Payer: Cigna of CA PPO |
$2,461.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,988.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,988.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,988.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,658.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,875.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,176.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,461.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,461.20
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,758.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,109.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,284.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,256.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,151.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,988.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,988.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,988.60
|
|
|
HC BE SPLIT SKT STMP ACTIVAT LOCK
|
Facility
|
OP
|
$6,016.00
|
|
|
Service Code
|
CPT L6130
|
| Hospital Charge Code |
905356130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,443.84 |
| Max. Negotiated Rate |
$5,113.60 |
| Rate for Payer: Galaxy Health WC |
$5,113.60
|
| Rate for Payer: Adventist Health Commercial |
$2,466.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,113.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,308.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,512.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,484.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,439.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,923.78
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cigna of CA HMO |
$4,211.20
|
| Rate for Payer: Cigna of CA PPO |
$4,211.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,113.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,113.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,609.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,076.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,012.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,723.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,211.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,211.20
|
| Rate for Payer: Multiplan Commercial |
$4,812.80
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,257.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,197.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,150.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,970.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,113.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,113.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,113.60
|
|
|
HC BE SPLIT SKT STMP ACTIVAT LOCK
|
Facility
|
IP
|
$6,016.00
|
|
|
Service Code
|
CPT L6130
|
| Hospital Charge Code |
905356130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,203.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cigna of CA HMO |
$4,211.20
|
| Rate for Payer: Cigna of CA PPO |
$4,211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.40
|
| Rate for Payer: Galaxy Health WC |
$5,113.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,609.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,012.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,292.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,723.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.84
|
| Rate for Payer: Multiplan Commercial |
$4,812.80
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,257.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,197.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,150.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,970.24
|
|
|
HC BE SPLIT SKT STMP ACTIVAT LOCK
|
Facility
|
OP
|
$6,016.00
|
|
|
Service Code
|
CPT L6130
|
| Hospital Charge Code |
915356130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,443.84 |
| Max. Negotiated Rate |
$5,113.60 |
| Rate for Payer: Adventist Health Commercial |
$2,466.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,113.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,308.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,512.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,484.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,439.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,923.78
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cigna of CA HMO |
$4,211.20
|
| Rate for Payer: Cigna of CA PPO |
$4,211.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,113.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,113.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.40
|
| Rate for Payer: Galaxy Health WC |
$5,113.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,609.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,076.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,012.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,723.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,211.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,211.20
|
| Rate for Payer: Multiplan Commercial |
$4,812.80
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,257.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,197.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,150.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,970.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,113.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,113.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,113.60
|
|
|
HC BE SPLIT SKT STMP ACTIVAT LOCK
|
Facility
|
IP
|
$6,016.00
|
|
|
Service Code
|
CPT L6130
|
| Hospital Charge Code |
915356130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,203.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cigna of CA HMO |
$4,211.20
|
| Rate for Payer: Cigna of CA PPO |
$4,211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.40
|
| Rate for Payer: Galaxy Health WC |
$5,113.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,609.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,012.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,292.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,723.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.84
|
| Rate for Payer: Multiplan Commercial |
$4,812.80
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,257.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,197.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,150.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,970.24
|
|
|
HC BETA HCG POC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$74.21 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.21
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Senior |
$7.52
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.09
|
| Rate for Payer: United Healthcare All Other HMO |
$6.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$7.52
|
|
|
HC BETA HCG POC
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Senior |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.12
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC BETA HCG, QUAL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$74.21 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.21
|
| Rate for Payer: Blue Shield of California Commercial |
$50.84
|
| Rate for Payer: Blue Shield of California EPN |
$33.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Senior |
$7.52
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.09
|
| Rate for Payer: United Healthcare All Other HMO |
$6.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$7.52
|
|
|
HC BETA HCG, QUAL
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Senior |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.12
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC BETA HCG, QUANT
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$142.30 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.30
|
| Rate for Payer: Blue Shield of California Commercial |
$84.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.69
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC BETA HCG, QUANT
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$80.26 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.26
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Senior |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
|
|
HC BETAMETHASONE SOD PHOS ACET3MG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
910400060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.14
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
|
|
HC BETAMETHASONE SOD PHOS ACET3MG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
910400060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
OP
|
$91.77
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$18.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$61.39
|
| Rate for Payer: Blue Shield of California EPN |
$40.56
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cigna of CA HMO |
$58.73
|
| Rate for Payer: Cigna of CA PPO |
$67.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.69
|
| Rate for Payer: EPIC Health Plan Senior |
$16.81
|
| Rate for Payer: Galaxy Health WC |
$78.00
|
| Rate for Payer: Global Benefits Group Commercial |
$55.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.53
|
| Rate for Payer: Multiplan Commercial |
$73.42
|
| Rate for Payer: Networks By Design Commercial |
$59.65
|
| Rate for Payer: Prime Health Services Commercial |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.62
|
| Rate for Payer: United Healthcare All Other HMO |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Vantage Medical Group Senior |
$16.81
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
915356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO |
$701.40
|
| Rate for Payer: Cigna of CA PPO |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Multiplan Commercial |
$801.60
|
| Rate for Payer: Networks By Design Commercial |
$501.00
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.05
|
| Rate for Payer: United Healthcare All Other HMO |
$366.03
|
| Rate for Payer: United Healthcare HMO Rider |
$358.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.15
|
|
