|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,232.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,074.44
|
| 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 |
$2,285.40
|
| 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
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT L6120
|
| Hospital Charge Code |
905356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,232.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,074.44
|
| 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 |
$2,285.40
|
| 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 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 |
$3,641.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,626.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,050.11
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,076.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,820.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,348.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,549.44
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,820.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,549.44
|
| 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 |
$3,910.40
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,820.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,549.44
|
| 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 |
$3,910.40
|
| 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 |
905356130
|
|
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 |
$3,641.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,626.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,050.11
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,076.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,820.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,348.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,549.44
|
| 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 BETA HCG POC
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.28
|
| 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 Medi-Cal |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.55
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Blue Shield of California Commercial |
$86.67
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$131.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.41
|
| Rate for Payer: EPIC Health Plan Senior |
$8.27
|
| Rate for Payer: EPIC Health Plan Senior |
$8.27
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$119.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.12
|
| 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 Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| 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 Commercial |
$6.09
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.52
|
| 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 Commercial/Exchange |
$11.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$7.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$131.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$119.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.92
|
| 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
|
$188.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.28
|
| 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 Medi-Cal |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.55
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California Commercial |
$86.67
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$131.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.41
|
| Rate for Payer: EPIC Health Plan Senior |
$8.27
|
| Rate for Payer: EPIC Health Plan Senior |
$8.27
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$119.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.12
|
| 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 Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| 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 Commercial |
$6.09
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.52
|
| 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 Commercial/Exchange |
$11.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$7.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$131.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$119.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.92
|
| 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 |
$148.71 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| 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 Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.71
|
| Rate for Payer: Blue Shield of California Commercial |
$206.99
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$312.95
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$287.36
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$332.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| 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 All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| 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 Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| 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
|
$260.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| 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 Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.87
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California Commercial |
$119.86
|
| Rate for Payer: Blue Shield of California Commercial |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$181.22
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA HMO |
$166.40
|
| Rate for Payer: Cigna of CA PPO |
$192.40
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.01
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| 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 Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| 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 Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.17
|
| 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 Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| 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
|
OP
|
$30.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
910400060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$43.09 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.09
|
| 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 |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| 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 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 |
$15.21
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.42
|
| 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
|
$138.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.21
|
| 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 Medi-Cal |
$18.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$21.67
|
| Rate for Payer: Blue Shield of California Commercial |
$63.62
|
| Rate for Payer: Blue Shield of California Commercial |
$32.76
|
| Rate for Payer: Blue Shield of California Commercial |
$96.19
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.74
|
| Rate for Payer: EPIC Health Plan Senior |
$18.49
|
| Rate for Payer: EPIC Health Plan Senior |
$18.49
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.74
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.53
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.62
|
| 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 All Other HMO |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.81
|
| 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 Commercial/Exchange |
$25.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Vantage Medical Group Senior |
$16.81
|
| Rate for Payer: Vantage Medical Group Senior |
$16.81
|
|
|
HC BET V 2 (SILVER BIRCH), IGE
|
Facility
|
IP
|
$19.55
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.62 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$15.64
|
| Rate for Payer: Networks By Design Commercial |
$12.71
|
| Rate for Payer: Prime Health Services Commercial |
$16.62
|
|
|
HC BET V 2 (SILVER BIRCH), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$170.73 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Blue Shield of California Commercial |
$13.63
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$9.01
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Cigna of CA PPO |
$14.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Galaxy Health WC |
$16.62
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$12.33
|
| Rate for Payer: Networks By Design Commercial |
$12.71
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Commercial |
$16.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.18
|
| 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 |
$651.30
|
| 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
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
905356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.18
|
| 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 |
$651.30
|
| 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
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
905356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.48 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: Adventist Health Commercial |
$410.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$551.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$751.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.51
|
| Rate for Payer: Blue Shield of California Commercial |
$770.54
|
| Rate for Payer: Blue Shield of California Commercial |
$508.01
|
| 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: Dignity Health Commercial/Exchange |
$851.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$851.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$851.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$701.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$701.40
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$851.70
|
| Rate for Payer: Vantage Medical Group Senior |
$851.70
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
915356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.48 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: Adventist Health Commercial |
$410.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$551.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$751.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.51
|
| Rate for Payer: Blue Shield of California Commercial |
$770.54
|
| Rate for Payer: Blue Shield of California Commercial |
$508.01
|
| 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: Dignity Health Commercial/Exchange |
$851.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$851.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$851.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$701.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$701.40
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$851.70
|
| Rate for Payer: Vantage Medical Group Senior |
$851.70
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
915356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.04 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: Adventist Health Commercial |
$213.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$315.36
|
| Rate for Payer: Blue Shield of California Commercial |
$400.65
|
| Rate for Payer: Blue Shield of California Commercial |
$264.15
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.70
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.53
|
| Rate for Payer: United Healthcare All Other HMO |
$190.32
|
| Rate for Payer: United Healthcare HMO Rider |
$186.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
