|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$202.91 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| 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 Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.91
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$52.09
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Blue Shield of California Commercial |
$78.76
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| 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 Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.66
|
| Rate for Payer: Blue Shield of California Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$50.25
|
| Rate for Payer: Blue Shield of California Commercial |
$66.22
|
| Rate for Payer: Blue Shield of California Commercial |
$75.97
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Senior |
$9.78
|
| Rate for Payer: EPIC Health Plan Senior |
$9.78
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Senior |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$176.22 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.22
|
| Rate for Payer: Blue Shield of California Commercial |
$121.28
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California Commercial |
$80.21
|
| Rate for Payer: Blue Shield of California Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.70
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.24
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$141.76 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.76
|
| Rate for Payer: Blue Shield of California Commercial |
$64.54
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California Commercial |
$97.58
|
| Rate for Payer: Blue Shield of California Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$202.91 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| 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 Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.28
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| 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 All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| 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 Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC HIV RAPID TESTING
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| 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 |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| 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 |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| 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 |
$107.10
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| 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 |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| 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 |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| 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 |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| 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 RAPID TESTING
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
905352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$117.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.72
|
| Rate for Payer: Blue Shield of California Commercial |
$220.70
|
| Rate for Payer: Blue Shield of California Commercial |
$145.51
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
915352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
915352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$117.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.72
|
| Rate for Payer: Blue Shield of California Commercial |
$220.70
|
| Rate for Payer: Blue Shield of California Commercial |
$145.51
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
905352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Other HMO |
$104.84
|
| Rate for Payer: United Healthcare HMO Rider |
$102.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.99
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
915352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$968.48
|
| Rate for Payer: Blue Shield of California Commercial |
$811.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,230.40
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,360.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$474.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,120.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,360.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$1,040.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
915352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$968.48
|
| Rate for Payer: Blue Shield of California Commercial |
$811.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,230.40
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,360.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$474.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,120.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.48
|
| Rate for Payer: United Healthcare All Other HMO |
$584.48
|
| Rate for Payer: United Healthcare HMO Rider |
$571.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,360.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,360.00
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
915352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$1,470.50 |
| Rate for Payer: Adventist Health Commercial |
$709.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$951.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,297.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,047.17
|
| Rate for Payer: Blue Shield of California Commercial |
$877.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,330.37
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,470.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,020.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,211.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,211.00
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,038.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,038.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,470.50
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
IP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
915352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$346.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,020.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
IP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
905352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$346.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,020.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
|
|
HC HKAFO TORSION CBL BALL BEARING
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
CPT L2060
|
| Hospital Charge Code |
905352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$1,470.50 |
| Rate for Payer: Adventist Health Commercial |
$709.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$951.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,297.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,047.17
|
| Rate for Payer: Blue Shield of California Commercial |
$877.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,330.37
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,470.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,020.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,211.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,211.00
|
| Rate for Payer: Multiplan Commercial |
$1,384.00
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,038.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,038.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.27
|
| Rate for Payer: United Healthcare All Other HMO |
$631.97
|
| Rate for Payer: United Healthcare HMO Rider |
$618.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,470.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,470.50
|
|
|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
915352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.43
|
| Rate for Payer: Blue Shield of California Commercial |
$98.36
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
