|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
IP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$82.15 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$73.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$68.46
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
OP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$82.15 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.61
|
| Rate for Payer: Blue Shield of California Commercial |
$55.77
|
| Rate for Payer: Blue Shield of California EPN |
$36.42
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Central Health Plan Commercial |
$73.02
|
| Rate for Payer: Cigna of CA HMO |
$58.42
|
| Rate for Payer: Cigna of CA PPO |
$67.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$45.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$68.46
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
| Rate for Payer: Riverside University Health System MISP |
$36.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.64
|
| Rate for Payer: United Healthcare All Other HMO |
$45.64
|
| Rate for Payer: United Healthcare HMO Rider |
$45.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.59
|
| Rate for Payer: Vantage Medical Group Senior |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
OP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.57
|
| Rate for Payer: Blue Shield of California Commercial |
$48.45
|
| Rate for Payer: Blue Shield of California EPN |
$31.64
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Central Health Plan Commercial |
$63.43
|
| Rate for Payer: Cigna of CA HMO |
$50.75
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$39.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$59.47
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
| Rate for Payer: Riverside University Health System MISP |
$31.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.65
|
| Rate for Payer: United Healthcare All Other HMO |
$39.65
|
| Rate for Payer: United Healthcare HMO Rider |
$39.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.40
|
| Rate for Payer: Vantage Medical Group Senior |
$67.40
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
IP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Central Health Plan Commercial |
$63.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Multiplan Commercial |
$59.47
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
|
|
HC DRSNG WOUND VAC XLG
|
Facility
|
OP
|
$548.74
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901692012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$493.87 |
| Rate for Payer: Adventist Health Commercial |
$109.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$411.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$265.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.28
|
| Rate for Payer: Blue Shield of California Commercial |
$335.28
|
| Rate for Payer: Blue Shield of California EPN |
$218.95
|
| Rate for Payer: Cash Price |
$301.81
|
| Rate for Payer: Cash Price |
$301.81
|
| Rate for Payer: Central Health Plan Commercial |
$438.99
|
| Rate for Payer: Cigna of CA HMO |
$351.19
|
| Rate for Payer: Cigna of CA PPO |
$406.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$466.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$466.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.50
|
| Rate for Payer: EPIC Health Plan Senior |
$219.50
|
| Rate for Payer: Galaxy Health WC |
$466.43
|
| Rate for Payer: Global Benefits Group Commercial |
$329.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$493.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$274.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.12
|
| Rate for Payer: Multiplan Commercial |
$411.56
|
| Rate for Payer: Networks By Design Commercial |
$356.68
|
| Rate for Payer: Prime Health Services Commercial |
$466.43
|
| Rate for Payer: Riverside University Health System MISP |
$219.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.37
|
| Rate for Payer: United Healthcare All Other HMO |
$274.37
|
| Rate for Payer: United Healthcare HMO Rider |
$274.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$466.43
|
| Rate for Payer: Vantage Medical Group Senior |
$466.43
|
|
|
HC DRSNG WOUND VAC XLG
|
Facility
|
IP
|
$548.74
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901692012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$493.87 |
| Rate for Payer: Adventist Health Commercial |
$109.75
|
| Rate for Payer: Cash Price |
$301.81
|
| Rate for Payer: Central Health Plan Commercial |
$438.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.50
|
| Rate for Payer: EPIC Health Plan Senior |
$219.50
|
| Rate for Payer: Galaxy Health WC |
$466.43
|
| Rate for Payer: Global Benefits Group Commercial |
$329.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$493.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$411.56
|
| Rate for Payer: Networks By Design Commercial |
$356.68
|
| Rate for Payer: Prime Health Services Commercial |
$466.43
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
OP
|
$29.27
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.19
|
| Rate for Payer: Blue Shield of California Commercial |
$17.88
|
| Rate for Payer: Blue Shield of California EPN |
$11.68
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Central Health Plan Commercial |
$23.42
|
| Rate for Payer: Cigna of CA HMO |
$18.73
|
| Rate for Payer: Cigna of CA PPO |
$21.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.34
|
| Rate for Payer: InnovAge PACE Commercial |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$21.95
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
| Rate for Payer: Riverside University Health System MISP |
$11.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO |
$14.63
|
| Rate for Payer: United Healthcare HMO Rider |
$14.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
IP
|
$29.27
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Central Health Plan Commercial |
$23.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$21.95
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BENZODIAZPINES
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN BENZODIAZPINES
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN CANNABINOIDS
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN CANNABINOIDS
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN COCAINE
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN COCAINE
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN OPIATES
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$146.89
|
| Rate for Payer: Blue Shield of California EPN |
$96.07
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN OPIATES
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC DRUG SCREEN PHENCYCLIDINE
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911147
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
