|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$87.71 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.71
|
| Rate for Payer: Blue Shield of California Commercial |
$63.55
|
| Rate for Payer: Blue Shield of California EPN |
$41.99
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
IP
|
$174.33
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$148.18 |
| Rate for Payer: Adventist Health Commercial |
$34.87
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.73
|
| Rate for Payer: EPIC Health Plan Senior |
$69.73
|
| Rate for Payer: Galaxy Health WC |
$148.18
|
| Rate for Payer: Global Benefits Group Commercial |
$104.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.84
|
| Rate for Payer: Multiplan Commercial |
$139.46
|
| Rate for Payer: Networks By Design Commercial |
$113.31
|
| Rate for Payer: Prime Health Services Commercial |
$148.18
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$156.90
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$168.64 |
| Rate for Payer: Adventist Health Commercial |
$31.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.64
|
| Rate for Payer: Blue Shield of California Commercial |
$104.97
|
| Rate for Payer: Blue Shield of California EPN |
$69.35
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cigna of CA HMO |
$100.42
|
| Rate for Payer: Cigna of CA PPO |
$116.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.48
|
| Rate for Payer: EPIC Health Plan Senior |
$24.06
|
| Rate for Payer: Galaxy Health WC |
$133.37
|
| Rate for Payer: Global Benefits Group Commercial |
$94.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.24
|
| Rate for Payer: Multiplan Commercial |
$125.52
|
| Rate for Payer: Networks By Design Commercial |
$101.98
|
| Rate for Payer: Prime Health Services Commercial |
$133.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
IP
|
$154.26
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Adventist Health Commercial |
$30.85
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.70
|
| Rate for Payer: EPIC Health Plan Senior |
$61.70
|
| Rate for Payer: Galaxy Health WC |
$131.12
|
| Rate for Payer: Global Benefits Group Commercial |
$92.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.02
|
| Rate for Payer: Multiplan Commercial |
$123.41
|
| Rate for Payer: Networks By Design Commercial |
$100.27
|
| Rate for Payer: Prime Health Services Commercial |
$131.12
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Adventist Health Commercial |
$28.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.65
|
| Rate for Payer: Blue Shield of California Commercial |
$93.82
|
| Rate for Payer: Blue Shield of California EPN |
$61.99
|
| Rate for Payer: Cash Price |
$63.11
|
| Rate for Payer: Cash Price |
$63.11
|
| Rate for Payer: Cigna of CA HMO |
$89.75
|
| Rate for Payer: Cigna of CA PPO |
$103.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$119.20
|
| Rate for Payer: Global Benefits Group Commercial |
$84.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$112.19
|
| Rate for Payer: Networks By Design Commercial |
$91.16
|
| Rate for Payer: Prime Health Services Commercial |
$119.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$194.17 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| 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 |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| 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 |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| 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 |
$28.01
|
| 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 |
$10.08
|
| 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 |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| 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 RAPID TESTING
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC HIV RAPID TESTING
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$139.58 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.64
|
| 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 |
$84.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.69
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| 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 |
$84.04
|
| 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 |
$30.24
|
| 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 |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 HKAFO ROTATION STRAPS
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
915352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
915352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$117.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.23
|
| Rate for Payer: Blue Shield of California Commercial |
$211.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.48
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
905352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$117.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.23
|
| Rate for Payer: Blue Shield of California Commercial |
$211.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.48
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
905352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
915352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,180.80
|
| Rate for Payer: Blue Shield of California EPN |
$777.60
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,120.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,360.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,180.80
|
| Rate for Payer: Blue Shield of California EPN |
$777.60
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,120.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,360.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
915352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
IP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
915352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$346.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
905352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$1,470.50 |
| Rate for Payer: Adventist Health Commercial |
$709.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$951.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,297.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,276.74
|
| Rate for Payer: Blue Shield of California EPN |
$840.78
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,470.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,211.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,211.00
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,038.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,038.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,470.50
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
915352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$1,470.50 |
| Rate for Payer: Adventist Health Commercial |
$709.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$951.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,297.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,276.74
|
| Rate for Payer: Blue Shield of California EPN |
$840.78
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,470.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,211.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,211.00
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,038.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,038.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,470.50
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
IP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
905352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$346.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
|
|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
905352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.36
|
| Rate for Payer: Blue Shield of California Commercial |
$143.17
|
| Rate for Payer: Blue Shield of California EPN |
$94.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
915352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
