|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
915356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.48
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,378.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
|
|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
905356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.48
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,378.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
|
|
HC BE MOLD SKT MUENSTER SUSPENSN
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
CPT L6110
|
| Hospital Charge Code |
905356110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,467.40 |
| Max. Negotiated Rate |
$4,207.50 |
| 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 |
$2,745.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,613.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,356.20
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| 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: Health Management Network EPO/PPO |
$4,207.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,467.40
|
| Rate for Payer: InnovAge PACE Commercial |
$2,337.50
|
| 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 |
$1,916.75
|
| 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 |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,870.00
|
| 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 |
905356110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$935.00 |
| Max. Negotiated Rate |
$4,207.50 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,613.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,356.20
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| 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: Health Management Network EPO/PPO |
$4,207.50
|
| 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 |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$3,038.75
|
| 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 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 |
$1,467.40 |
| Max. Negotiated Rate |
$4,207.50 |
| 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 |
$2,745.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,613.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,356.20
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| 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: Health Management Network EPO/PPO |
$4,207.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,467.40
|
| Rate for Payer: InnovAge PACE Commercial |
$2,337.50
|
| 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 |
$1,916.75
|
| 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 |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,870.00
|
| 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 |
$4,207.50 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,613.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,356.20
|
| Rate for Payer: Cash Price |
$2,571.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| 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: Health Management Network EPO/PPO |
$4,207.50
|
| 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 |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$3,038.75
|
| 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
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.29
|
| 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 Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.19
|
| Rate for Payer: Blue Shield of California Commercial |
$157.21
|
| Rate for Payer: Blue Shield of California EPN |
$102.82
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| 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: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: InnovAge PACE Commercial |
$129.50
|
| 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 |
$51.80
|
| 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 |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Riverside University Health System MISP |
$103.60
|
| 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 BENZODIAZPINES CONF
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| 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: Health Management Network EPO/PPO |
$233.10
|
| 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 |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
|
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 |
$1,151.49 |
| Max. Negotiated Rate |
$3,164.40 |
| 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 |
$2,064.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,717.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,772.06
|
| Rate for Payer: Cash Price |
$1,933.80
|
| Rate for Payer: Cash Price |
$1,933.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,812.80
|
| 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: Health Management Network EPO/PPO |
$3,164.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,697.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,758.00
|
| 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 |
$1,441.56
|
| 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 |
$2,637.00
|
| Rate for Payer: Networks By Design Commercial |
$1,758.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,406.40
|
| 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
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT L6120
|
| Hospital Charge Code |
915356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,151.49 |
| Max. Negotiated Rate |
$3,164.40 |
| 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 |
$2,064.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,717.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,772.06
|
| Rate for Payer: Cash Price |
$1,933.80
|
| Rate for Payer: Cash Price |
$1,933.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,812.80
|
| 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: Health Management Network EPO/PPO |
$3,164.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,697.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,758.00
|
| 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 |
$1,441.56
|
| 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 |
$2,637.00
|
| Rate for Payer: Networks By Design Commercial |
$1,758.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,406.40
|
| 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 |
$3,164.40 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,717.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,772.06
|
| Rate for Payer: Cash Price |
$1,933.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,812.80
|
| 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: Health Management Network EPO/PPO |
$3,164.40
|
| 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 |
$703.20
|
| Rate for Payer: Multiplan Commercial |
$2,637.00
|
| 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 |
915356120
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$3,164.40 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,717.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,772.06
|
| Rate for Payer: Cash Price |
$1,933.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,812.80
|
| 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: Health Management Network EPO/PPO |
$3,164.40
|
| 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 |
$703.20
|
| Rate for Payer: Multiplan Commercial |
$2,637.00
|
| 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 |
$1,970.24 |
| Max. Negotiated Rate |
$5,414.40 |
| 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 |
$3,533.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,650.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,032.06
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,812.80
|
| 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: Health Management Network EPO/PPO |
$5,414.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,126.14
|
| Rate for Payer: InnovAge PACE Commercial |
$3,008.00
|
| 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 |
$2,466.56
|
| 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 |
$4,512.00
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,406.40
|
| 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 |
$5,414.40 |
| Rate for Payer: Adventist Health Commercial |
$1,203.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,650.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,032.06
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,812.80
|
| 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: Health Management Network EPO/PPO |
$5,414.40
|
| 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 |
$1,203.20
|
| Rate for Payer: Multiplan Commercial |
$4,512.00
|
| 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 |
$1,970.24 |
| Max. Negotiated Rate |
$5,414.40 |
| 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 |
$3,533.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,650.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,032.06
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,812.80
|
| 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: Health Management Network EPO/PPO |
$5,414.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,126.14
|
| Rate for Payer: InnovAge PACE Commercial |
$3,008.00
|
| 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 |
$2,466.56
|
| 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 |
$4,512.00
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,406.40
|
| 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 |
$5,414.40 |
| Rate for Payer: Adventist Health Commercial |
$1,203.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,650.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,032.06
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,812.80
|
| 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: Health Management Network EPO/PPO |
$5,414.40
|
| 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 |
$1,203.20
|
| Rate for Payer: Multiplan Commercial |
$4,512.00
|
| 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 BETA HCG POC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
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 |
$54.66 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| 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 Exchange |
$54.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| 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: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: InnovAge PACE Commercial |
$11.28
|
| 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 |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.52
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$7.97
|
| Rate for Payer: Riverside University Health System MISP |
$8.27
|
| 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, QUAL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
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 |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| 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 Exchange |
$54.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.09
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| 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: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: InnovAge PACE Commercial |
$11.28
|
| 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 |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.52
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$7.97
|
| Rate for Payer: Riverside University Health System MISP |
$8.27
|
| 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, 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 |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| 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 Exchange |
$104.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.27
|
| Rate for Payer: Blue Shield of California Commercial |
$76.48
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| 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: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: InnovAge PACE Commercial |
$22.57
|
| 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 |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Riverside University Health System MISP |
$16.55
|
| 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
|
$126.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
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 |
$59.12 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| 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 Exchange |
$59.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| 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: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: InnovAge PACE Commercial |
$12.26
|
| 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 |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.17
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$8.66
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| 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 STREP RAPID TEST
|
Facility
|
OP
|
$91.77
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$82.59 |
| Rate for Payer: Adventist Health Commercial |
$18.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.73
|
| 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 Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$55.70
|
| Rate for Payer: Blue Shield of California EPN |
$36.43
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Central Health Plan Commercial |
$73.42
|
| 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: Health Management Network EPO/PPO |
$82.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.81
|
| Rate for Payer: InnovAge PACE Commercial |
$25.21
|
| 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 |
$18.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.53
|
| Rate for Payer: Multiplan Commercial |
$68.83
|
| Rate for Payer: Networks By Design Commercial |
$59.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Medicare |
$17.82
|
| Rate for Payer: Riverside University Health System MISP |
$18.49
|
| 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
|
|
