|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
915352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
915352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.67 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Adventist Health Commercial |
$392.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.29
|
| Rate for Payer: Blue Shield of California Commercial |
$706.27
|
| Rate for Payer: Blue Shield of California EPN |
$465.10
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.90
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.45
|
| Rate for Payer: Vantage Medical Group Senior |
$813.45
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.67 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Adventist Health Commercial |
$392.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.29
|
| Rate for Payer: Blue Shield of California Commercial |
$706.27
|
| Rate for Payer: Blue Shield of California EPN |
$465.10
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.90
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.45
|
| Rate for Payer: Vantage Medical Group Senior |
$813.45
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
915352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.36 |
| Max. Negotiated Rate |
$1,371.90 |
| Rate for Payer: Adventist Health Commercial |
$661.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$934.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.13
|
| Rate for Payer: Blue Shield of California EPN |
$784.40
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$432.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.36 |
| Max. Negotiated Rate |
$1,371.90 |
| Rate for Payer: Adventist Health Commercial |
$661.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$934.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.13
|
| Rate for Payer: Blue Shield of California EPN |
$784.40
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$432.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
915352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
915352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.36 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: Adventist Health Commercial |
$487.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$653.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$891.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.67
|
| Rate for Payer: Blue Shield of California Commercial |
$877.48
|
| Rate for Payer: Blue Shield of California EPN |
$577.85
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,010.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,010.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$832.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$832.30
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$713.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$713.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,010.65
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.36 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: Adventist Health Commercial |
$487.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$653.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$891.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.67
|
| Rate for Payer: Blue Shield of California Commercial |
$877.48
|
| Rate for Payer: Blue Shield of California EPN |
$577.85
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,010.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,010.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$832.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$832.30
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$713.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$713.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,010.65
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
915352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
|
|
HC HIP JT LOCK EA
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
915352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC HIP JT LOCK EA
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
915352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.89
|
| Rate for Payer: Blue Shield of California Commercial |
$749.07
|
| Rate for Payer: Blue Shield of California EPN |
$493.29
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC HIP JT LOCK EA
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$587.89
|
| Rate for Payer: Blue Shield of California Commercial |
$749.07
|
| Rate for Payer: Blue Shield of California EPN |
$493.29
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC HIP JT LOCK EA
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$232.81
|
| Rate for Payer: Blue Shield of California EPN |
$153.82
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC HISTONE AUTO AB
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$139.58 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$101.02
|
| Rate for Payer: Blue Shield of California EPN |
$66.74
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Senior |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$146.69 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.69
|
| Rate for Payer: Blue Shield of California Commercial |
$19.40
|
| Rate for Payer: Blue Shield of California EPN |
$12.82
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Senior |
$24.08
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$194.17 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.17
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Senior |
$24.08
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
