|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$622.05
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$1,049.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
915352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.36 |
| Max. Negotiated Rate |
$1,371.90 |
| Rate for Payer: Adventist Health Commercial |
$661.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$976.95
|
| Rate for Payer: Blue Shield of California Commercial |
$818.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.17
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$432.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.36 |
| Max. Negotiated Rate |
$1,371.90 |
| Rate for Payer: Adventist Health Commercial |
$661.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$976.95
|
| Rate for Payer: Blue Shield of California Commercial |
$818.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.17
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$432.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
915352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$1,049.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$755.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$701.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$772.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
915352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.36 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: Adventist Health Commercial |
$487.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$653.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$891.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.70
|
| Rate for Payer: Blue Shield of California Commercial |
$914.34
|
| Rate for Payer: Blue Shield of California Commercial |
$602.82
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,010.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,010.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$755.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$701.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$832.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$832.30
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$713.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$713.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,010.65
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
915352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$755.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$701.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$772.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.36 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: Adventist Health Commercial |
$487.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$653.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$891.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.70
|
| Rate for Payer: Blue Shield of California Commercial |
$914.34
|
| Rate for Payer: Blue Shield of California Commercial |
$602.82
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,010.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,010.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$755.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$701.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$832.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$832.30
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$713.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$713.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,010.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,010.65
|
|
|
HC HIP JT LOCK EA
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
915352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$659.75
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC HIP JT LOCK EA
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.38
|
| Rate for Payer: Blue Shield of California Commercial |
$780.53
|
| Rate for Payer: Blue Shield of California Commercial |
$514.61
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$370.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
|
|
HC HIP JT LOCK EA
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
915352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.38
|
| Rate for Payer: Blue Shield of California Commercial |
$780.53
|
| Rate for Payer: Blue Shield of California Commercial |
$514.61
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$370.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC HIP JT LOCK EA
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: Networks By Design Commercial |
$659.75
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Blue Shield of California Commercial |
$160.43
|
| Rate for Payer: Blue Shield of California Commercial |
$486.82
|
| Rate for Payer: Blue Shield of California Commercial |
$242.56
|
| Rate for Payer: Blue Shield of California Commercial |
$736.03
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$243.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$29.50
|
| Rate for Payer: Blue Shield of California Commercial |
$129.64
|
| Rate for Payer: Blue Shield of California Commercial |
$44.61
|
| Rate for Payer: Blue Shield of California Commercial |
$85.75
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HISTONE AUTO AB
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC HISTOTRIPSY MLGNT HPTCLLR TISSUE
|
Facility
|
IP
|
$55,078.00
|
|
|
Service Code
|
CPT 0686T
|
| Hospital Charge Code |
906811874
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,015.60 |
| Max. Negotiated Rate |
$46,816.30 |
| Rate for Payer: Adventist Health Commercial |
$11,015.60
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38,554.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,031.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,031.20
|
| Rate for Payer: Galaxy Health WC |
$46,816.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33,046.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,974.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,496.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,218.72
|
| Rate for Payer: Multiplan Commercial |
$44,062.40
|
| Rate for Payer: Networks By Design Commercial |
$35,800.70
|
| Rate for Payer: Prime Health Services Commercial |
$46,816.30
|
|
|
HC HISTOTRIPSY MLGNT HPTCLLR TISSUE
|
Facility
|
OP
|
$55,078.00
|
|
|
Service Code
|
CPT 0686T
|
| Hospital Charge Code |
906811874
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$46,816.30 |
| Rate for Payer: Adventist Health Commercial |
$11,015.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,047.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,234.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,031.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Cigna of CA HMO |
$35,249.92
|
| Rate for Payer: Cigna of CA PPO |
$40,757.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,047.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,234.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,031.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38,554.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,351.78
|
| Rate for Payer: EPIC Health Plan Senior |
$24,234.52
|
| Rate for Payer: Galaxy Health WC |
$46,816.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33,046.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,131.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,031.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,974.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,993.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,843.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,218.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,759.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,522.05
|
| Rate for Payer: Multiplan Commercial |
$44,062.40
|
| Rate for Payer: Networks By Design Commercial |
$35,800.70
|
| Rate for Payer: Prime Health Services Commercial |
$46,816.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,046.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$27,539.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,539.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27,539.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,539.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,031.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,047.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,234.52
|
| Rate for Payer: Vantage Medical Group Senior |
$22,031.38
|
|
|
HC HIT SCREEN PF4 H AB
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
900912035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.84
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC HIT SCREEN PF4 H AB
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
900912035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$110.83 |
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.83
|
| Rate for Payer: Blue Shield of California Commercial |
$44.72
|
| Rate for Payer: Blue Shield of California Commercial |
$53.48
|
| Rate for Payer: Blue Shield of California Commercial |
$67.61
|
| Rate for Payer: Blue Shield of California Commercial |
$80.85
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna of CA HMO |
$62.08
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Cigna of CA PPO |
$71.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Senior |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| 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 Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.86
|
| Rate for Payer: Blue Shield of California Commercial |
$117.56
|
| Rate for Payer: Blue Shield of California Commercial |
$105.25
|
| Rate for Payer: Blue Shield of California Commercial |
$177.74
|
| Rate for Payer: Blue Shield of California Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.09
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| 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 All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| 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 Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$205.72 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.72
|
| 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 |
$153.29
|
| Rate for Payer: Blue Shield of California Commercial |
$13.37
|
| Rate for Payer: Blue Shield of California Commercial |
$20.21
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
