|
HC BELOW/ABOVE ELBOW LOCK MECH
|
Facility
|
IP
|
$1,542.13
|
|
|
Service Code
|
CPT L6698
|
| Hospital Charge Code |
905356698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$308.43 |
| Max. Negotiated Rate |
$1,387.92 |
| Rate for Payer: Blue Shield of California EPN |
$823.50
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Central Health Plan Commercial |
$1,233.70
|
| Rate for Payer: Cigna of CA HMO |
$1,079.49
|
| Rate for Payer: Cigna of CA PPO |
$1,079.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$616.85
|
| Rate for Payer: Galaxy Health WC |
$1,310.81
|
| Rate for Payer: Global Benefits Group Commercial |
$925.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,387.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,028.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.43
|
| Rate for Payer: Multiplan Commercial |
$1,156.60
|
| Rate for Payer: Networks By Design Commercial |
$771.06
|
| Rate for Payer: Prime Health Services Commercial |
$1,310.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.31
|
| Rate for Payer: United Healthcare All Other HMO |
$568.74
|
| Rate for Payer: United Healthcare HMO Rider |
$556.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.90
|
|
|
HC BELOW/ABOVE ELBOW LOCK MECH
|
Facility
|
OP
|
$1,542.13
|
|
|
Service Code
|
CPT L6698
|
| Hospital Charge Code |
905356698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$539.75 |
| Max. Negotiated Rate |
$1,387.92 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$848.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$746.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$911.09
|
| Rate for Payer: Blue Distinction Transplant |
$925.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,156.60
|
| Rate for Payer: Blue Shield of California EPN |
$838.92
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Central Health Plan Commercial |
$1,233.70
|
| Rate for Payer: Cigna of CA HMO |
$1,079.49
|
| Rate for Payer: Cigna of CA PPO |
$1,079.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Dignity Health Media |
$1,310.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$616.85
|
| Rate for Payer: Galaxy Health WC |
$1,310.81
|
| Rate for Payer: Global Benefits Group Commercial |
$925.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,387.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,156.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$539.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,028.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.27
|
| Rate for Payer: Multiplan Commercial |
$1,156.60
|
| Rate for Payer: Networks By Design Commercial |
$771.06
|
| Rate for Payer: Prime Health Services Commercial |
$1,310.81
|
| Rate for Payer: Riverside University Health System MISP |
$616.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$925.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$925.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$771.06
|
| Rate for Payer: United Healthcare All Other HMO |
$771.06
|
| Rate for Payer: United Healthcare HMO Rider |
$771.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$771.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,310.81
|
|
|
HC BELOW KNEE SUS/SEAL SLEEVE
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT L5685
|
| Hospital Charge Code |
905355685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.47
|
| Rate for Payer: Blue Distinction Transplant |
$151.80
|
| Rate for Payer: Blue Shield of California Commercial |
$189.75
|
| Rate for Payer: Blue Shield of California EPN |
$137.63
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$177.10
|
| Rate for Payer: Cigna of CA PPO |
$177.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Media |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$189.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.73
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$126.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Riverside University Health System MISP |
$101.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.50
|
| Rate for Payer: United Healthcare All Other HMO |
$126.50
|
| Rate for Payer: United Healthcare HMO Rider |
$126.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC BELOW KNEE SUS/SEAL SLEEVE
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT L5685
|
| Hospital Charge Code |
905355685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Blue Shield of California EPN |
$135.10
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$177.10
|
| Rate for Payer: Cigna of CA PPO |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$126.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.53
|
| Rate for Payer: United Healthcare All Other HMO |
$93.31
|
| Rate for Payer: United Healthcare HMO Rider |
$91.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.49
|
|
|
HC BELT BACK SUPPORT SMALL
|
Facility
|
IP
|
$88.62
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901603587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$79.76 |
| Rate for Payer: Blue Shield of California EPN |
$47.32
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Central Health Plan Commercial |
$70.90
|
| Rate for Payer: Cigna of CA HMO |
$62.03
|
| Rate for Payer: Cigna of CA PPO |
$62.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.45
|
| Rate for Payer: Galaxy Health WC |
$75.33
|
| Rate for Payer: Global Benefits Group Commercial |
$53.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.72
|
| Rate for Payer: Multiplan Commercial |
$66.46
|
| Rate for Payer: Networks By Design Commercial |
$44.31
|
| Rate for Payer: Prime Health Services Commercial |
$75.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.46
|
| Rate for Payer: United Healthcare All Other HMO |
$32.68
|
| Rate for Payer: United Healthcare HMO Rider |
$31.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.24
|
|
|
HC BELT BACK SUPPORT SMALL
|
Facility
|
OP
|
$88.62
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901603587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$79.76 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.36
|
| Rate for Payer: Blue Distinction Transplant |
$53.17
|
| Rate for Payer: Blue Shield of California Commercial |
$66.46
|
| Rate for Payer: Blue Shield of California EPN |
$48.21
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Central Health Plan Commercial |
$70.90
|
| Rate for Payer: Cigna of CA HMO |
$62.03
|
| Rate for Payer: Cigna of CA PPO |
$62.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.33
|
| Rate for Payer: Dignity Health Media |
$75.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.45
|
| Rate for Payer: Galaxy Health WC |
$75.33
|
| Rate for Payer: Global Benefits Group Commercial |
$53.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$66.46
|
| Rate for Payer: Networks By Design Commercial |
$44.31
|
| Rate for Payer: Prime Health Services Commercial |
$75.33
|
| Rate for Payer: Riverside University Health System MISP |
$35.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.31
|
| Rate for Payer: United Healthcare All Other HMO |
$44.31
|
| Rate for Payer: United Healthcare HMO Rider |
$44.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.33
|
| Rate for Payer: Vantage Medical Group Senior |
$75.33
|
|
|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
905356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$742.00 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,026.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.50
|
| Rate for Payer: Blue Distinction Transplant |
$1,272.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,590.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,153.28
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| 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: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Media |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,590.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$742.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.20
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: Riverside University Health System MISP |
$848.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,060.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.00
|
|
|
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: Blue Shield of California EPN |
$1,132.08
|
| Rate for Payer: Cash Price |
$954.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$424.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$800.51
|
| Rate for Payer: United Healthcare All Other HMO |
$781.86
|
| Rate for Payer: United Healthcare HMO Rider |
$764.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$699.60
|
|
|
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 |
$1,620.97 |
| Max. Negotiated Rate |
$4,207.50 |
| 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 |
$2,571.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,263.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,761.99
|
| Rate for Payer: Blue Distinction Transplant |
$2,805.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,506.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,543.20
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| 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 Media |
$3,973.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,973.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3,506.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,636.25
|
| 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: LLUH Dept of Risk Management WC |
$1,916.75
|
| 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 |
$2,337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,337.50
|
| 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: Blue Shield of California EPN |
$2,496.45
|
| Rate for Payer: Cash Price |
$2,103.75
|
| 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 Transplant |
$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 |
$1,781.18
|
| 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 |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,765.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,724.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,686.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,542.75
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.41
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
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 |
$1,230.60 |
| Max. Negotiated Rate |
$3,164.40 |
| 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 |
$1,933.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,702.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,077.25
|
| Rate for Payer: Blue Distinction Transplant |
$2,109.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,637.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,912.70
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| 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 Media |
$2,988.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,988.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,637.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,230.60
|
| 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: LLUH Dept of Risk Management WC |
$1,441.56
|
| 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 |
$1,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,758.00
|
| 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: Blue Shield of California EPN |
$1,877.54
|
| Rate for Payer: Cash Price |
$1,582.20
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$703.20
|
| 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: United Healthcare All Other Commercial |
$1,327.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,296.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,268.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,160.28
|
|
|
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 |
$2,105.60 |
| Max. Negotiated Rate |
$5,414.40 |
| 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 |
$3,308.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,912.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,554.25
|
| Rate for Payer: Blue Distinction Transplant |
$3,609.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,512.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,272.70
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| 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 Media |
$5,113.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$4,512.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,105.60
|
| 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: LLUH Dept of Risk Management WC |
$2,466.56
|
| 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 |
$3,008.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,008.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,008.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,008.00
|
| 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: Blue Shield of California EPN |
$3,212.54
|
| Rate for Payer: Cash Price |
$2,707.20
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$1,203.20
|
| Rate for Payer: Multiplan Commercial |
$4,512.00
|
| Rate for Payer: Networks By Design Commercial |
$3,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,271.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,218.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,170.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,985.28
|
|
|
HC BETA HCG POC
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC BETA HCG POC
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| 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 |
$66.67
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Media |
$7.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.52
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.41
|
| 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 |
$11.34
|
| 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 |
$3.40
|
| 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 |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| 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 |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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: 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
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$66.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| 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 |
$66.67
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Media |
$7.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.52
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.41
|
| 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 |
$18.68
|
| 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 |
$5.60
|
| 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 |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| 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 |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| 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: 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
|
$170.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC BETA HCG, QUANT
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$127.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.56
|
| 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 |
$127.84
|
| Rate for Payer: Blue Distinction Transplant |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$35.23
|
| Rate for Payer: Blue Shield of California EPN |
$27.70
|
| Rate for Payer: Caremore Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Media |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: InnovAge PACE Commercial |
$22.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| 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 |
$11.40
|
| 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 |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Riverside University Health System MISP |
$16.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| 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 HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC BETA HCG, QUANT
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$72.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| 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 |
$72.11
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Media |
$8.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.48
|
| 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 |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| 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 |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| 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 |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.22
|
| 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 |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$16.81
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.22
|
| Rate for Payer: Dignity Health Media |
$16.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.81
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.81
|
| Rate for Payer: InnovAge PACE Commercial |
$25.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| 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 |
$7.20
|
| 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 |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| 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 |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Vantage Medical Group Senior |
$16.81
|
|
