|
HC BETA STREP RAPID TEST
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
905356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.70 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$551.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$551.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$485.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$591.98
|
| Rate for Payer: Blue Distinction Transplant |
$601.20
|
| Rate for Payer: Blue Shield of California Commercial |
$751.50
|
| Rate for Payer: Blue Shield of California EPN |
$545.09
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$701.40
|
| Rate for Payer: Cigna of CA PPO |
$701.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.70
|
| Rate for Payer: Dignity Health Media |
$851.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$851.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$751.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.82
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$501.00
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Riverside University Health System MISP |
$400.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$501.00
|
| Rate for Payer: United Healthcare All Other HMO |
$501.00
|
| Rate for Payer: United Healthcare HMO Rider |
$501.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$851.70
|
| Rate for Payer: Vantage Medical Group Senior |
$851.70
|
|
|
HC BE/WD ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT L6687
|
| Hospital Charge Code |
905356687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Blue Shield of California EPN |
$535.07
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$701.40
|
| Rate for Payer: Cigna of CA PPO |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$501.00
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.36
|
| Rate for Payer: United Healthcare All Other HMO |
$369.54
|
| Rate for Payer: United Healthcare HMO Rider |
$361.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.66
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
905356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.35 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.81
|
| Rate for Payer: Blue Distinction Transplant |
$312.60
|
| Rate for Payer: Blue Shield of California Commercial |
$390.75
|
| Rate for Payer: Blue Shield of California EPN |
$283.42
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.85
|
| Rate for Payer: Dignity Health Media |
$442.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$390.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.61
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: Riverside University Health System MISP |
$208.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.50
|
| Rate for Payer: United Healthcare All Other HMO |
$260.50
|
| Rate for Payer: United Healthcare HMO Rider |
$260.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.85
|
| Rate for Payer: Vantage Medical Group Senior |
$442.85
|
|
|
HC BE/WD ADDITION TEST SOCKET
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT L6680
|
| Hospital Charge Code |
905356680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$468.90 |
| Rate for Payer: Blue Shield of California EPN |
$278.21
|
| Rate for Payer: Cash Price |
$234.45
|
| Rate for Payer: Central Health Plan Commercial |
$416.80
|
| Rate for Payer: Cigna of CA HMO |
$364.70
|
| Rate for Payer: Cigna of CA PPO |
$364.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.40
|
| Rate for Payer: Galaxy Health WC |
$442.85
|
| Rate for Payer: Global Benefits Group Commercial |
$312.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.20
|
| Rate for Payer: Multiplan Commercial |
$390.75
|
| Rate for Payer: Networks By Design Commercial |
$260.50
|
| Rate for Payer: Prime Health Services Commercial |
$442.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.73
|
| Rate for Payer: United Healthcare All Other HMO |
$192.14
|
| Rate for Payer: United Healthcare HMO Rider |
$187.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.93
|
|
|
HC BE/WD IPOP CAST CHANGE
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L6386
|
| Hospital Charge Code |
905356386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.65 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$415.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.50
|
| Rate for Payer: Blue Distinction Transplant |
$515.40
|
| Rate for Payer: Blue Shield of California Commercial |
$644.25
|
| Rate for Payer: Blue Shield of California EPN |
$467.30
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Media |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$644.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.19
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Riverside University Health System MISP |
$343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$429.50
|
| Rate for Payer: United Healthcare All Other HMO |
$429.50
|
| Rate for Payer: United Healthcare HMO Rider |
$429.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC BE/WD IPOP CAST CHANGE
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L6386
|
| Hospital Charge Code |
905356386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Blue Shield of California EPN |
$458.71
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.80
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.36
|
| Rate for Payer: United Healthcare All Other HMO |
$316.80
|
| Rate for Payer: United Healthcare HMO Rider |
$309.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.47
|
|
|
HC BE/WD IPOP INCL 1 CAST CHANGE
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
CPT L6380
|
| Hospital Charge Code |
905356380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,108.05
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,660.00
|
| Rate for Payer: Cigna of CA HMO |
$1,452.50
|
| Rate for Payer: Cigna of CA PPO |
$1,452.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,867.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$790.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Multiplan Commercial |
$1,556.25
|
| Rate for Payer: Networks By Design Commercial |
$1,037.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.52
|
| Rate for Payer: United Healthcare All Other HMO |
$765.26
|
| Rate for Payer: United Healthcare HMO Rider |
$748.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.75
|
|
|
HC BE/WD IPOP INCL 1 CAST CHANGE
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
CPT L6380
|
| Hospital Charge Code |
905356380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$726.25 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,004.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.91
|
| Rate for Payer: Blue Distinction Transplant |
$1,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,556.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,128.80
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Cash Price |
$933.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,660.00
|
| Rate for Payer: Cigna of CA HMO |
$1,452.50
|
| Rate for Payer: Cigna of CA PPO |
$1,452.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,763.75
|
| Rate for Payer: Dignity Health Media |
$1,763.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,763.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$830.00
|
| Rate for Payer: Galaxy Health WC |
$1,763.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,245.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,867.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,556.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$726.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,384.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.75
|
| Rate for Payer: Multiplan Commercial |
$1,556.25
|
| Rate for Payer: Networks By Design Commercial |
$1,037.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,763.75
|
| Rate for Payer: Riverside University Health System MISP |
$830.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,245.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,245.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,037.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,037.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,037.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,763.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,763.75
|
|
|
HC BE/WD PREP MOLDED TO MODEL
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
CPT L6580
|
| Hospital Charge Code |
905356580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.40 |
| Max. Negotiated Rate |
$1,216.80 |
| Rate for Payer: Blue Shield of California EPN |
$721.97
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,081.60
|
| Rate for Payer: Cigna of CA HMO |
$946.40
|
| Rate for Payer: Cigna of CA PPO |
$946.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$540.80
|
| Rate for Payer: Galaxy Health WC |
$1,149.20
|
| Rate for Payer: Global Benefits Group Commercial |
$811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,216.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$901.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.40
|
| Rate for Payer: Multiplan Commercial |
$1,014.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.52
|
| Rate for Payer: United Healthcare All Other HMO |
$498.62
|
| Rate for Payer: United Healthcare HMO Rider |
$487.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$446.16
|
|
|
HC BE/WD PREP MOLDED TO MODEL
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT L6580
|
| Hospital Charge Code |
905356580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$1,564.42 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,149.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$743.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$743.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$654.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.76
|
| Rate for Payer: Blue Distinction Transplant |
$811.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,014.00
|
| Rate for Payer: Blue Shield of California EPN |
$735.49
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,081.60
|
| Rate for Payer: Cigna of CA HMO |
$946.40
|
| Rate for Payer: Cigna of CA PPO |
$946.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,149.20
|
| Rate for Payer: Dignity Health Media |
$1,149.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,149.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$540.80
|
| Rate for Payer: Galaxy Health WC |
$1,149.20
|
| Rate for Payer: Global Benefits Group Commercial |
$811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,216.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,014.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$473.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$901.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.32
|
| Rate for Payer: Multiplan Commercial |
$1,014.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.20
|
| Rate for Payer: Riverside University Health System MISP |
$540.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$676.00
|
| Rate for Payer: United Healthcare HMO Rider |
$676.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,149.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,149.20
|
|
|
HC BE/WD PREP MOLDED TO PATIENT
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT L6582
|
| Hospital Charge Code |
905356582
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$438.55 |
| Max. Negotiated Rate |
$1,234.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$689.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$606.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.27
|
| Rate for Payer: Blue Distinction Transplant |
$751.80
|
| Rate for Payer: Blue Shield of California Commercial |
$939.75
|
| Rate for Payer: Blue Shield of California EPN |
$681.63
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,002.40
|
| Rate for Payer: Cigna of CA HMO |
$877.10
|
| Rate for Payer: Cigna of CA PPO |
$877.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.05
|
| Rate for Payer: Dignity Health Media |
$1,065.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,065.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,127.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$939.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$438.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,234.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.73
|
| Rate for Payer: Multiplan Commercial |
$939.75
|
| Rate for Payer: Networks By Design Commercial |
$626.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: Riverside University Health System MISP |
$501.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$751.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$626.50
|
| Rate for Payer: United Healthcare All Other HMO |
$626.50
|
| Rate for Payer: United Healthcare HMO Rider |
$626.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$626.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,065.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,065.05
|
|
|
HC BE/WD PREP MOLDED TO PATIENT
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT L6582
|
| Hospital Charge Code |
905356582
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$1,127.70 |
| Rate for Payer: Blue Shield of California EPN |
$669.10
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,002.40
|
| Rate for Payer: Cigna of CA HMO |
$877.10
|
| Rate for Payer: Cigna of CA PPO |
$877.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,127.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.60
|
| Rate for Payer: Multiplan Commercial |
$939.75
|
| Rate for Payer: Networks By Design Commercial |
$626.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$473.13
|
| Rate for Payer: United Healthcare All Other HMO |
$462.11
|
| Rate for Payer: United Healthcare HMO Rider |
$452.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.49
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$490.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$391.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.37
|
| Rate for Payer: Blue Distinction Transplant |
$484.80
|
| Rate for Payer: Blue Shield of California Commercial |
$508.23
|
| Rate for Payer: Blue Shield of California EPN |
$395.11
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Media |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Riverside University Health System MISP |
$323.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$949.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$860.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$757.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.01
|
| Rate for Payer: Blue Distinction Transplant |
$938.40
|
| Rate for Payer: Blue Shield of California Commercial |
$983.76
|
| Rate for Payer: Blue Shield of California EPN |
$764.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,251.20
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Dignity Health Media |
$1,329.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,329.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,407.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,173.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$547.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.00
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
| Rate for Payer: Riverside University Health System MISP |
$625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.00
|
| Rate for Payer: United Healthcare All Other HMO |
$782.00
|
| Rate for Payer: United Healthcare HMO Rider |
$782.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,329.40
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,407.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.00
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$190.80
|
| Rate for Payer: Blue Shield of California Commercial |
$200.02
|
| Rate for Payer: Blue Shield of California EPN |
$155.50
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Central Health Plan Commercial |
$254.40
|
| Rate for Payer: Cigna of CA HMO |
$203.52
|
| Rate for Payer: Cigna of CA PPO |
$235.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$238.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.00
|
| Rate for Payer: United Healthcare All Other HMO |
$159.00
|
| Rate for Payer: United Healthcare HMO Rider |
$159.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Central Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.27
|
| Rate for Payer: Blue Distinction Transplant |
$232.80
|
| Rate for Payer: Blue Shield of California Commercial |
$239.78
|
| Rate for Payer: Blue Shield of California EPN |
$188.57
|
| Rate for Payer: Caremore Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Media |
$13.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.68
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: InnovAge PACE Commercial |
$20.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Prime Health Services Medicare |
$14.50
|
| Rate for Payer: Riverside University Health System MISP |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
