|
HC HKAFO TORSION CABLES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.72 |
| Max. Negotiated Rate |
$1,440.00 |
| 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 |
$939.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,236.80
|
| Rate for Payer: Blue Shield of California EPN |
$806.40
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$429.72
|
| Rate for Payer: InnovAge PACE Commercial |
$800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.00
|
| 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 |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Riverside University Health System MISP |
$640.00
|
| 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
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
915352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.72 |
| Max. Negotiated Rate |
$1,440.00 |
| 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 |
$939.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,236.80
|
| Rate for Payer: Blue Shield of California EPN |
$806.40
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.00
|
| Rate for Payer: Cigna of CA HMO |
$1,120.00
|
| Rate for Payer: Cigna of CA PPO |
$1,120.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$640.00
|
| Rate for Payer: Galaxy Health WC |
$1,360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$429.72
|
| Rate for Payer: InnovAge PACE Commercial |
$800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$990.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.00
|
| 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 |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$800.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.00
|
| Rate for Payer: Riverside University Health System MISP |
$640.00
|
| 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 |
905352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$566.58 |
| Max. Negotiated Rate |
$1,557.00 |
| 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 |
$1,016.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.29
|
| Rate for Payer: Blue Shield of California EPN |
$871.92
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,384.00
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,470.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,557.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.92
|
| Rate for Payer: InnovAge PACE Commercial |
$865.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$709.30
|
| 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 |
$1,297.50
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Riverside University Health System MISP |
$692.00
|
| 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 |
$1,557.00 |
| Rate for Payer: Adventist Health Commercial |
$346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.29
|
| Rate for Payer: Blue Shield of California EPN |
$871.92
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,384.00
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,557.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Multiplan Commercial |
$1,297.50
|
| 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 |
$1,557.00 |
| Rate for Payer: Adventist Health Commercial |
$346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.29
|
| Rate for Payer: Blue Shield of California EPN |
$871.92
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,384.00
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,557.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Multiplan Commercial |
$1,297.50
|
| 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 |
915352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$566.58 |
| Max. Negotiated Rate |
$1,557.00 |
| 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 |
$1,016.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.29
|
| Rate for Payer: Blue Shield of California EPN |
$871.92
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,384.00
|
| Rate for Payer: Cigna of CA HMO |
$1,211.00
|
| Rate for Payer: Cigna of CA PPO |
$1,211.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,470.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Senior |
$692.00
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,557.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.92
|
| Rate for Payer: InnovAge PACE Commercial |
$865.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$709.30
|
| 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 |
$1,297.50
|
| Rate for Payer: Networks By Design Commercial |
$865.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Riverside University Health System MISP |
$692.00
|
| 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
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
905352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| 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
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
905352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$174.60 |
| 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 |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.07
|
| Rate for Payer: InnovAge PACE Commercial |
$97.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.54
|
| 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 |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Riverside University Health System MISP |
$77.60
|
| 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 |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| 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
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
915352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$174.60 |
| 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 |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.07
|
| Rate for Payer: InnovAge PACE Commercial |
$97.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.54
|
| 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 |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Riverside University Health System MISP |
$77.60
|
| 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 TORSION CABLE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
915352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$253.16 |
| Max. Negotiated Rate |
$695.70 |
| 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 |
$453.98
|
| Rate for Payer: Blue Shield of California Commercial |
$597.53
|
| Rate for Payer: Blue Shield of California EPN |
$389.59
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Central Health Plan Commercial |
$618.40
|
| 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: 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: Health Management Network EPO/PPO |
$695.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298.97
|
| Rate for Payer: InnovAge PACE Commercial |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.93
|
| 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 |
$579.75
|
| Rate for Payer: Networks By Design Commercial |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Riverside University Health System MISP |
$309.20
|
| 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 |
$695.70 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California Commercial |
$597.53
|
| Rate for Payer: Blue Shield of California EPN |
$389.59
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Central Health Plan Commercial |
$618.40
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$695.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.60
|
| Rate for Payer: Multiplan Commercial |
$579.75
|
| 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
|
IP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
915352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California Commercial |
$597.53
|
| Rate for Payer: Blue Shield of California EPN |
$389.59
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Central Health Plan Commercial |
$618.40
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$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: Health Management Network EPO/PPO |
$695.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.60
|
| Rate for Payer: Multiplan Commercial |
$579.75
|
| 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 |
905352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$253.16 |
| Max. Negotiated Rate |
$695.70 |
| 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 |
$453.98
|
| Rate for Payer: Blue Shield of California Commercial |
$597.53
|
| Rate for Payer: Blue Shield of California EPN |
$389.59
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Central Health Plan Commercial |
$618.40
|
| 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: 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: Health Management Network EPO/PPO |
$695.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298.97
|
| Rate for Payer: InnovAge PACE Commercial |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.93
|
| 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 |
$579.75
|
| Rate for Payer: Networks By Design Commercial |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Riverside University Health System MISP |
$309.20
|
| 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 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 |
$772.20 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Blue Shield of California Commercial |
$663.23
|
| Rate for Payer: Blue Shield of California EPN |
$432.43
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$643.50
|
| 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
|
IP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
905352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Blue Shield of California Commercial |
$663.23
|
| Rate for Payer: Blue Shield of California EPN |
$432.43
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$643.50
|
| 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 |
915352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$772.20 |
| 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 |
$503.90
|
| Rate for Payer: Blue Shield of California Commercial |
$663.23
|
| Rate for Payer: Blue Shield of California EPN |
$432.43
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| 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: 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: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$454.51
|
| Rate for Payer: InnovAge PACE Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.78
|
| 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 |
$643.50
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Riverside University Health System MISP |
$343.20
|
| 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
|
OP
|
$858.00
|
|
|
Service Code
|
CPT L2090
|
| Hospital Charge Code |
905352090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$772.20 |
| 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 |
$503.90
|
| Rate for Payer: Blue Shield of California Commercial |
$663.23
|
| Rate for Payer: Blue Shield of California EPN |
$432.43
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| 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: 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: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$454.51
|
| Rate for Payer: InnovAge PACE Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.78
|
| 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 |
$643.50
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Riverside University Health System MISP |
$343.20
|
| 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 HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| 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: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| 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
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$801.40 |
| Max. Negotiated Rate |
$3,606.30 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,205.60
|
| 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: Health Management Network EPO/PPO |
$3,606.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,480.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.40
|
| Rate for Payer: Multiplan Commercial |
$3,005.25
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.37
|
| 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 Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.35
|
| Rate for Payer: Blue Shield of California Commercial |
$861.94
|
| Rate for Payer: Blue Shield of California EPN |
$563.74
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: InnovAge PACE Commercial |
$185.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| 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
|
OP
|
$3,340.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,006.00 |
| Rate for Payer: Adventist Health Commercial |
$668.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$335.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,028.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,724.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$553.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,325.98
|
| Rate for Payer: Cash Price |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,503.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,672.00
|
| Rate for Payer: Cigna of CA HMO |
$2,137.60
|
| Rate for Payer: Cigna of CA PPO |
$2,471.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.76
|
| Rate for Payer: EPIC Health Plan Senior |
$335.38
|
| Rate for Payer: Galaxy Health WC |
$2,839.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,006.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$512.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: InnovAge PACE Commercial |
$503.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,227.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$2,505.00
|
| Rate for Payer: Networks By Design Commercial |
$2,171.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$335.38
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.00
|
| Rate for Payer: Prime Health Services Medicare |
$355.50
|
| Rate for Payer: Riverside University Health System MISP |
$368.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,004.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,004.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$335.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.37
|
| 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 Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.35
|
| Rate for Payer: Blue Shield of California Commercial |
$861.94
|
| Rate for Payer: Blue Shield of California EPN |
$563.74
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: InnovAge PACE Commercial |
$185.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| 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: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| 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
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| 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: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
