|
HC HKAFO UNILAT TRSN BALL BEARING
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
905352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.01
|
| Rate for Payer: United Healthcare All Other HMO |
$313.43
|
| Rate for Payer: United Healthcare HMO Rider |
$306.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,699.63 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,628.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,699.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,680.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,771.09
|
| Rate for Payer: Cash Price |
$2,203.85
|
| Rate for Payer: Cash Price |
$2,203.85
|
| Rate for Payer: Cigna of CA HMO |
$2,564.48
|
| Rate for Payer: Cigna of CA PPO |
$2,965.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.76
|
| Rate for Payer: EPIC Health Plan Senior |
$335.38
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,404.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$335.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$801.40 |
| Max. Negotiated Rate |
$3,405.95 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Cash Price |
$2,203.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,602.80
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,480.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,184.80
|
| Rate for Payer: Blue Shield of California EPN |
$782.78
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,184.80
|
| Rate for Payer: Blue Shield of California EPN |
$782.78
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,239.70
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,184.80
|
| Rate for Payer: Blue Shield of California EPN |
$782.78
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC HLA A B C DR DQ DP MOLECULA
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$325.72 |
| Max. Negotiated Rate |
$1,989.85 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,535.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,632.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,566.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,034.72
|
| Rate for Payer: Cash Price |
$1,287.55
|
| Rate for Payer: Cash Price |
$1,287.55
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.86
|
| Rate for Payer: EPIC Health Plan Senior |
$402.12
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$659.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$600.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$402.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.84
|
| Rate for Payer: Multiplan Commercial |
$1,872.80
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.72
|
| Rate for Payer: United Healthcare All Other HMO |
$325.72
|
| Rate for Payer: United Healthcare HMO Rider |
$325.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$402.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Vantage Medical Group Senior |
$402.12
|
|
|
HC HLA A B C DR DQ DP MOLECULA
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$1,989.85 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,287.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.84
|
| Rate for Payer: Multiplan Commercial |
$1,872.80
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,335.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,362.08
|
| Rate for Payer: Blue Shield of California EPN |
$899.91
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cigna of CA HMO |
$1,303.04
|
| Rate for Payer: Cigna of CA PPO |
$1,506.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,221.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,335.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,362.08
|
| Rate for Payer: Blue Shield of California EPN |
$899.91
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cigna of CA HMO |
$1,303.04
|
| Rate for Payer: Cigna of CA PPO |
$1,506.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,221.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$814.40
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$814.40
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$801.40 |
| Max. Negotiated Rate |
$3,405.95 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Cash Price |
$2,203.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,602.80
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,480.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
OP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,699.63 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,628.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,699.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,680.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,771.09
|
| Rate for Payer: Cash Price |
$2,203.85
|
| Rate for Payer: Cash Price |
$2,203.85
|
| Rate for Payer: Cigna of CA HMO |
$2,564.48
|
| Rate for Payer: Cigna of CA PPO |
$2,965.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.76
|
| Rate for Payer: EPIC Health Plan Senior |
$335.38
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,404.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$335.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.41
|
| Rate for Payer: Blue Shield of California Commercial |
$260.91
|
| Rate for Payer: Blue Shield of California EPN |
$172.38
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna of CA HMO |
$249.60
|
| Rate for Payer: Cigna of CA PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.66
|
| Rate for Payer: EPIC Health Plan Senior |
$64.19
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.01
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.99
|
| Rate for Payer: United Healthcare All Other HMO |
$51.99
|
| Rate for Payer: United Healthcare HMO Rider |
$51.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Vantage Medical Group Senior |
$64.19
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,246.10 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$907.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$3,525.54 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$961.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,525.54
|
| Rate for Payer: Blue Shield of California Commercial |
$980.75
|
| Rate for Payer: Blue Shield of California EPN |
$647.97
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cigna of CA HMO |
$938.24
|
| Rate for Payer: Cigna of CA PPO |
$1,084.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$403.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.85
|
| Rate for Payer: EPIC Health Plan Senior |
$403.59
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$403.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$540.81
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$879.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.91
|
| Rate for Payer: United Healthcare All Other HMO |
$326.91
|
| Rate for Payer: United Healthcare HMO Rider |
$326.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$403.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Vantage Medical Group Senior |
$403.59
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$344.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$250.80
|
| Rate for Payer: Galaxy Health WC |
$532.95
|
| Rate for Payer: Global Benefits Group Commercial |
$376.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.48
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: Networks By Design Commercial |
$407.55
|
| Rate for Payer: Prime Health Services Commercial |
$532.95
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$572.74 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$411.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.74
|
| Rate for Payer: Blue Shield of California Commercial |
$419.46
|
| Rate for Payer: Blue Shield of California EPN |
$277.13
|
| Rate for Payer: Cash Price |
$344.85
|
| Rate for Payer: Cash Price |
$344.85
|
| Rate for Payer: Cigna of CA HMO |
$401.28
|
| Rate for Payer: Cigna of CA PPO |
$463.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.30
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$532.95
|
| Rate for Payer: Global Benefits Group Commercial |
$376.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: Networks By Design Commercial |
$407.55
|
| Rate for Payer: Prime Health Services Commercial |
$532.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$376.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$376.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO |
$46.98
|
| Rate for Payer: United Healthcare HMO Rider |
$46.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$1,059.56 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.56
|
| Rate for Payer: Blue Shield of California Commercial |
$658.30
|
| Rate for Payer: Blue Shield of California EPN |
$434.93
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Senior |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
