|
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 |
$106.70
|
| Rate for Payer: Cash Price |
$106.70
|
| 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 |
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 |
$106.70
|
| 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
|
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 |
$106.70
|
| 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 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 |
$425.15
|
| 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 |
$425.15
|
| Rate for Payer: Cash Price |
$425.15
|
| 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
|
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 |
$425.15
|
| Rate for Payer: Cash Price |
$425.15
|
| 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 |
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 |
$425.15
|
| 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 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 |
$471.90
|
| 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 |
$471.90
|
| 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 |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| 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 |
$471.90
|
| Rate for Payer: Cash Price |
$471.90
|
| 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
|
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 |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| 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
|
$1,420.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
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 |
$1,837.00
|
| Rate for Payer: Cash Price |
$1,837.00
|
| 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
|
IP
|
$3,340.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$668.00 |
| Max. Negotiated Rate |
$3,006.00 |
| Rate for Payer: Adventist Health Commercial |
$668.00
|
| Rate for Payer: Cash Price |
$1,837.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,336.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,227.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,272.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,067.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.00
|
| Rate for Payer: Networks By Design Commercial |
$2,171.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.00
|
|
|
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 |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| 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: Anthem Blue Cross of CA Exchange |
$687.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.97
|
| 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 |
$781.00
|
| 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 |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| 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: InnovAge PACE Commercial |
$710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Riverside University Health System MISP |
$568.00
|
| 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 |
$710.00
|
| Rate for Payer: United Healthcare All Other HMO |
$710.00
|
| Rate for Payer: United Healthcare HMO Rider |
$710.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.00
|
| 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 Senior |
$1,207.00
|
|
|
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 |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| 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
|
$1,420.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Cash Price |
$1,287.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| 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: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,449.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| 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 |
$244.04 |
| Max. Negotiated Rate |
$2,106.90 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$402.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,421.69
|
| 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 Exchange |
$1,202.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,420.99
|
| Rate for Payer: Blue Shield of California EPN |
$929.38
|
| Rate for Payer: Cash Price |
$1,287.55
|
| Rate for Payer: Cash Price |
$1,287.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.80
|
| Rate for Payer: Cigna of CA HMO |
$1,498.24
|
| Rate for Payer: Cigna of CA PPO |
$1,732.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.86
|
| Rate for Payer: EPIC Health Plan Senior |
$402.12
|
| Rate for Payer: Galaxy Health WC |
$1,989.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$659.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$614.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$402.12
|
| Rate for Payer: InnovAge PACE Commercial |
$603.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,561.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.84
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: Networks By Design Commercial |
$1,521.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$402.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.85
|
| Rate for Payer: Prime Health Services Medicare |
$426.25
|
| Rate for Payer: Riverside University Health System MISP |
$442.33
|
| 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
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,832.40 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$814.40
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,832.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.20
|
| Rate for Payer: Multiplan Commercial |
$1,527.00
|
| 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 |
$1,832.40 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,236.46
|
| 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 Exchange |
$550.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,235.85
|
| Rate for Payer: Blue Shield of California EPN |
$808.29
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,628.80
|
| Rate for Payer: Cigna of CA HMO |
$1,303.04
|
| Rate for Payer: Cigna of CA PPO |
$1,506.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: InnovAge PACE Commercial |
$183.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,527.00
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.22
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
| Rate for Payer: Prime Health Services Medicare |
$129.55
|
| Rate for Payer: Riverside University Health System MISP |
$134.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,221.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,832.40 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,236.46
|
| 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 Exchange |
$550.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,235.85
|
| Rate for Payer: Blue Shield of California EPN |
$808.29
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,628.80
|
| Rate for Payer: Cigna of CA HMO |
$1,303.04
|
| Rate for Payer: Cigna of CA PPO |
$1,506.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: InnovAge PACE Commercial |
$183.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,527.00
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.22
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
| Rate for Payer: Prime Health Services Medicare |
$129.55
|
| Rate for Payer: Riverside University Health System MISP |
$134.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,221.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$407.20 |
| Max. Negotiated Rate |
$1,832.40 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$1,119.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$814.40
|
| Rate for Payer: Galaxy Health WC |
$1,730.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,221.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,832.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,260.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.20
|
| Rate for Payer: Multiplan Commercial |
$1,527.00
|
| Rate for Payer: Networks By Design Commercial |
$1,323.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,730.60
|
|
