|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HIT SCREEN PF4 H AB
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
900912035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC HIT SCREEN PF4 H AB
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
900912035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.29
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$12.46
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Media |
$12.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: InnovAge PACE Commercial |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Prime Health Services Medicare |
$13.21
|
| Rate for Payer: Riverside University Health System MISP |
$13.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.48
|
| Rate for Payer: Caremore Medicare Advantage |
$13.71
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Media |
$13.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: InnovAge PACE Commercial |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Prime Health Services Medicare |
$14.53
|
| Rate for Payer: Riverside University Health System MISP |
$15.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$177.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.44
|
| Rate for Payer: Blue Distinction Transplant |
$31.80
|
| Rate for Payer: Blue Shield of California Commercial |
$32.75
|
| Rate for Payer: Blue Shield of California EPN |
$25.76
|
| Rate for Payer: Caremore Medicare Advantage |
$24.08
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Media |
$24.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.08
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: InnovAge PACE Commercial |
$36.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.80
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: InnovAge PACE Commercial |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health System MISP |
$9.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$151.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.50
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$24.06
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Media |
$24.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.06
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: InnovAge PACE Commercial |
$36.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.24
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$26.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$121.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.87
|
| Rate for Payer: Blue Distinction Transplant |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Caremore Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Media |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: InnovAge PACE Commercial |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.44
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$24.08
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Media |
$24.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.08
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: InnovAge PACE Commercial |
$36.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC HIV RAPID TESTING
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: Blue Distinction Transplant |
$31.80
|
| Rate for Payer: Blue Shield of California Commercial |
$32.75
|
| Rate for Payer: Blue Shield of California EPN |
$25.76
|
| Rate for Payer: Caremore Medicare Advantage |
$13.71
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Media |
$13.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: InnovAge PACE Commercial |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Prime Health Services Medicare |
$14.53
|
| Rate for Payer: Riverside University Health System MISP |
$15.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV RAPID TESTING
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
905352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.56
|
| Rate for Payer: Blue Distinction Transplant |
$172.20
|
| Rate for Payer: Blue Shield of California Commercial |
$215.25
|
| Rate for Payer: Blue Shield of California EPN |
$156.13
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Media |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$215.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.67
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Riverside University Health System MISP |
$114.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.50
|
| Rate for Payer: United Healthcare All Other HMO |
$143.50
|
| Rate for Payer: United Healthcare HMO Rider |
$143.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC HKAFO ROTATION STRAPS
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT L2040
|
| Hospital Charge Code |
905352040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Blue Shield of California EPN |
$153.26
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Cigna of CA HMO |
$200.90
|
| Rate for Payer: Cigna of CA PPO |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$143.50
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.37
|
| Rate for Payer: United Healthcare All Other HMO |
$105.85
|
| Rate for Payer: United Healthcare HMO Rider |
$103.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.71
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Blue Shield of California EPN |
$854.40
|
| 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: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| 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: United Healthcare All Other Commercial |
$604.16
|
| Rate for Payer: United Healthcare All Other HMO |
$590.08
|
| Rate for Payer: United Healthcare HMO Rider |
$577.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
|
|
HC HKAFO TORSION CABLES
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT L2050
|
| Hospital Charge Code |
905352050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$474.70 |
| Max. Negotiated Rate |
$1,440.00 |
| 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 |
$880.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$774.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.28
|
| Rate for Payer: Blue Distinction Transplant |
$960.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,200.00
|
| Rate for Payer: Blue Shield of California EPN |
$870.40
|
| 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 Media |
$1,360.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,200.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$560.00
|
| 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: LLUH Dept of Risk Management WC |
$656.00
|
| 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 |
$800.00
|
| Rate for Payer: United Healthcare All Other HMO |
$800.00
|
| Rate for Payer: United Healthcare HMO Rider |
$800.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$800.00
|
| 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 |
$605.50 |
| Max. Negotiated Rate |
$1,557.00 |
| 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 |
$951.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$837.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,022.08
|
| Rate for Payer: Blue Distinction Transplant |
$1,038.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.50
|
| Rate for Payer: Blue Shield of California EPN |
$941.12
|
| 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 Media |
$1,470.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,470.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,297.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$605.50
|
| 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: LLUH Dept of Risk Management WC |
$709.30
|
| 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 |
$865.00
|
| Rate for Payer: United Healthcare All Other HMO |
$865.00
|
| Rate for Payer: United Healthcare HMO Rider |
$865.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$865.00
|
| 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 |
905352060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$1,557.00 |
| Rate for Payer: Blue Shield of California EPN |
$923.82
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$346.00
|
| 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: United Healthcare All Other Commercial |
$653.25
|
| Rate for Payer: United Healthcare All Other HMO |
$638.02
|
| Rate for Payer: United Healthcare HMO Rider |
$624.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.90
|
|
|
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: Blue Shield of California EPN |
$103.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$38.80
|
| 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: United Healthcare All Other Commercial |
$73.25
|
| Rate for Payer: United Healthcare All Other HMO |
$71.55
|
| Rate for Payer: United Healthcare HMO Rider |
$70.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.02
|
|
|
HC HKAFO UNILAT ROTATION STRAP
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L2070
|
| Hospital Charge Code |
905352070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$174.60 |
| 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 |
$106.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.62
|
| Rate for Payer: Blue Distinction Transplant |
$116.40
|
| Rate for Payer: Blue Shield of California Commercial |
$145.50
|
| Rate for Payer: Blue Shield of California EPN |
$105.54
|
| 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 Media |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$145.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.90
|
| 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: LLUH Dept of Risk Management WC |
$79.54
|
| 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 |
$97.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
