|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
905352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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
|
|
|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
915352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
905352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC HKAFO UNILAT TORSION CABLE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
905352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.52 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$316.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$579.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.90
|
| Rate for Payer: Blue Shield of California Commercial |
$594.44
|
| Rate for Payer: Blue Shield of California Commercial |
$391.91
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$541.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.10
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.11
|
| Rate for Payer: United Healthcare All Other HMO |
$282.38
|
| Rate for Payer: United Healthcare HMO Rider |
$276.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.05
|
| Rate for Payer: Vantage Medical Group Senior |
$657.05
|
|
|
HC HKAFO UNILAT TORSION CABLE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
905352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$541.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.11
|
| Rate for Payer: United Healthcare All Other HMO |
$282.38
|
| Rate for Payer: United Healthcare HMO Rider |
$276.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.16
|
|
|
HC HKAFO UNILAT TORSION CABLE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
915352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.52 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$316.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$579.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.90
|
| Rate for Payer: Blue Shield of California Commercial |
$594.44
|
| Rate for Payer: Blue Shield of California Commercial |
$391.91
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$541.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.10
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.11
|
| Rate for Payer: United Healthcare All Other HMO |
$282.38
|
| Rate for Payer: United Healthcare HMO Rider |
$276.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.05
|
| Rate for Payer: Vantage Medical Group Senior |
$657.05
|
|
|
HC HKAFO UNILAT TORSION CABLE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
915352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$541.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.11
|
| Rate for Payer: United Healthcare All Other HMO |
$282.38
|
| Rate for Payer: United Healthcare HMO Rider |
$276.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.16
|
|
|
HC HKAFO UNILAT TRSN BALL BEARING
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
915352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$729.30 |
| Rate for Payer: Adventist Health Commercial |
$351.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$643.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.35
|
| Rate for Payer: Blue Shield of California Commercial |
$659.80
|
| Rate for Payer: Blue Shield of California Commercial |
$435.01
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$729.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$729.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$729.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$600.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.01
|
| Rate for Payer: United Healthcare All Other HMO |
$313.43
|
| Rate for Payer: United Healthcare HMO Rider |
$306.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$729.30
|
| Rate for Payer: Vantage Medical Group Senior |
$729.30
|
|
|
HC HKAFO UNILAT TRSN BALL BEARING
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
905352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.01
|
| Rate for Payer: United Healthcare All Other HMO |
$313.43
|
| Rate for Payer: United Healthcare HMO Rider |
$306.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
|
|
HC HKAFO UNILAT TRSN BALL BEARING
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
905352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$729.30 |
| Rate for Payer: Adventist Health Commercial |
$351.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$643.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.35
|
| Rate for Payer: Blue Shield of California Commercial |
$659.80
|
| Rate for Payer: Blue Shield of California Commercial |
$435.01
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$729.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$729.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$729.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$600.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.01
|
| Rate for Payer: United Healthcare All Other HMO |
$313.43
|
| Rate for Payer: United Healthcare HMO Rider |
$306.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$729.30
|
| Rate for Payer: Vantage Medical Group Senior |
$729.30
|
|
|
HC HKAFO UNILAT TRSN BALL BEARING
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
915352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.92
|
| Rate for Payer: Multiplan Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.01
|
| Rate for Payer: United Healthcare All Other HMO |
$313.43
|
| Rate for Payer: United Healthcare HMO Rider |
$306.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$295.17
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.03 |
| Max. Negotiated Rate |
$869.31 |
| Rate for Payer: Adventist Health Commercial |
$59.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Blue Shield of California Commercial |
$136.07
|
| Rate for Payer: Blue Shield of California Commercial |
$205.73
|
| Rate for Payer: Cash Price |
$132.83
|
| Rate for Payer: Cash Price |
$132.83
|
| Rate for Payer: Cigna of CA HMO |
$188.91
|
| Rate for Payer: Cigna of CA PPO |
$218.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$250.89
|
| Rate for Payer: Global Benefits Group Commercial |
$177.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$236.14
|
| Rate for Payer: Networks By Design Commercial |
$191.86
|
| Rate for Payer: Prime Health Services Commercial |
$250.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$295.17
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.03 |
| Max. Negotiated Rate |
$250.89 |
| Rate for Payer: Adventist Health Commercial |
$59.03
|
| Rate for Payer: Cash Price |
$132.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.07
|
| Rate for Payer: EPIC Health Plan Senior |
$118.07
|
| Rate for Payer: Galaxy Health WC |
$250.89
|
| Rate for Payer: Global Benefits Group Commercial |
$177.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$236.14
|
| Rate for Payer: Networks By Design Commercial |
$191.86
|
| Rate for Payer: Prime Health Services Commercial |
$250.89
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$801.40 |
| Max. Negotiated Rate |
$3,405.95 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,804.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,602.80
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,544.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,364.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,866.09 |
| Rate for Payer: Adventist Health Commercial |
$668.00
|
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,622.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,622.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,866.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,866.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,847.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,539.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,792.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,327.98
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cash Price |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,503.00
|
| Rate for Payer: Cigna of CA HMO |
$2,564.48
|
| Rate for Payer: Cigna of CA HMO |
$2,137.60
|
| Rate for Payer: Cigna of CA PPO |
$2,471.60
|
| Rate for Payer: Cigna of CA PPO |
$2,965.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,338.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,804.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.38
|
| Rate for Payer: EPIC Health Plan Senior |
$368.92
|
| Rate for Payer: EPIC Health Plan Senior |
$368.92
|
| Rate for Payer: Galaxy Health WC |
$2,839.00
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,120.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,544.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Multiplan Commercial |
$2,672.00
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Networks By Design Commercial |
$2,171.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,004.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,404.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,004.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$335.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$335.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,234.39
|
| Rate for Payer: Blue Shield of California Commercial |
$654.62
|
| Rate for Payer: Blue Shield of California Commercial |
$816.43
|
| Rate for Payer: Blue Shield of California Commercial |
$989.74
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Multiplan Commercial |
$1,136.00
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$931.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,136.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$911.21
|
| Rate for Payer: Blue Shield of California Commercial |
$816.43
|
| Rate for Payer: Blue Shield of California Commercial |
$654.62
|
| Rate for Payer: Blue Shield of California Commercial |
$989.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,234.39
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,136.00
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$710.00
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$710.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
|
|
HC HLA A B C DR DQ DP MOLECULA
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$468.20 |
| Max. Negotiated Rate |
$1,989.85 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.40
|
| Rate for Payer: EPIC Health Plan Senior |
$936.40
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,486.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,381.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.84
|
| Rate for Payer: Multiplan Commercial |
$1,872.80
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
|
|
HC HLA A B C DR DQ DP MOLECULA
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$325.72 |
| Max. Negotiated Rate |
$1,989.85 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,945.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,706.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,631.68
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,638.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$663.50
|
| Rate for Payer: EPIC Health Plan Senior |
$442.33
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$659.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$600.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$402.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,486.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$679.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.84
|
| Rate for Payer: Multiplan Commercial |
$1,872.80
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.72
|
| Rate for Payer: United Healthcare All Other HMO |
$325.72
|
| Rate for Payer: United Healthcare HMO Rider |
$325.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$402.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Vantage Medical Group Senior |
$402.12
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$678.67
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$576.87 |
| Rate for Payer: Adventist Health Commercial |
$135.73
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.47
|
| Rate for Payer: EPIC Health Plan Senior |
$271.47
|
| Rate for Payer: Galaxy Health WC |
$576.87
|
| Rate for Payer: Global Benefits Group Commercial |
$407.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$430.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.88
|
| Rate for Payer: Multiplan Commercial |
$542.94
|
| Rate for Payer: Networks By Design Commercial |
$441.14
|
| Rate for Payer: Prime Health Services Commercial |
$576.87
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$678.67
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$780.57 |
| Rate for Payer: Adventist Health Commercial |
$135.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Blue Shield of California Commercial |
$312.87
|
| Rate for Payer: Blue Shield of California Commercial |
$473.03
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna of CA HMO |
$434.35
|
| Rate for Payer: Cigna of CA PPO |
$502.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$475.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$576.87
|
| Rate for Payer: Global Benefits Group Commercial |
$407.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$430.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$542.94
|
| Rate for Payer: Networks By Design Commercial |
$441.14
|
| Rate for Payer: Prime Health Services Commercial |
$576.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$407.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$407.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$814.40
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,201.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,730.60 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,419.09
|
| Rate for Payer: Blue Shield of California Commercial |
$938.60
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cigna of CA HMO |
$1,303.04
|
| Rate for Payer: Cigna of CA PPO |
$1,506.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,425.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,628.80
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,221.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
