|
HC HKAFO UNILAT TORSION CABLE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
905352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.55 |
| Max. Negotiated Rate |
$695.70 |
| 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 |
$425.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$374.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$456.69
|
| Rate for Payer: Blue Distinction Transplant |
$463.80
|
| Rate for Payer: Blue Shield of California Commercial |
$579.75
|
| Rate for Payer: Blue Shield of California EPN |
$420.51
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Central Health Plan Commercial |
$618.40
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$541.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.05
|
| Rate for Payer: Dignity Health Media |
$657.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$579.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.55
|
| 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: LLUH Dept of Risk Management WC |
$316.93
|
| 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 |
$386.50
|
| Rate for Payer: United Healthcare All Other HMO |
$386.50
|
| Rate for Payer: United Healthcare HMO Rider |
$386.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.05
|
| Rate for Payer: Vantage Medical Group Senior |
$657.05
|
|
|
HC HKAFO UNILAT TORSION CABLE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT L2080
|
| Hospital Charge Code |
905352080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Blue Shield of California EPN |
$412.78
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Central Health Plan Commercial |
$618.40
|
| Rate for Payer: Cigna of CA HMO |
$541.10
|
| Rate for Payer: Cigna of CA PPO |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$154.60
|
| 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: United Healthcare All Other Commercial |
$291.88
|
| Rate for Payer: United Healthcare All Other HMO |
$285.08
|
| Rate for Payer: United Healthcare HMO Rider |
$278.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.09
|
|
|
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: Blue Shield of California EPN |
$458.17
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$171.60
|
| 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: United Healthcare All Other Commercial |
$323.98
|
| Rate for Payer: United Healthcare All Other HMO |
$316.43
|
| Rate for Payer: United Healthcare HMO Rider |
$309.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.14
|
|
|
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 |
$300.30 |
| Max. Negotiated Rate |
$772.20 |
| 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 |
$471.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$415.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.91
|
| Rate for Payer: Blue Distinction Transplant |
$514.80
|
| Rate for Payer: Blue Shield of California Commercial |
$643.50
|
| Rate for Payer: Blue Shield of California EPN |
$466.75
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Cigna of CA HMO |
$600.60
|
| Rate for Payer: Cigna of CA PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$729.30
|
| Rate for Payer: Dignity Health Media |
$729.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$729.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$643.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.78
|
| 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 |
$429.00
|
| Rate for Payer: United Healthcare All Other HMO |
$429.00
|
| Rate for Payer: United Healthcare HMO Rider |
$429.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.00
|
| 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 MOLECULAR
|
Facility
|
IP
|
$2,395.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$479.00 |
| Max. Negotiated Rate |
$2,155.50 |
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,916.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$958.00
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,155.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Multiplan Commercial |
$1,796.25
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
|
|
HC HLA A B C DR DQ MOLECULAR
|
Facility
|
OP
|
$2,395.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$325.72 |
| Max. Negotiated Rate |
$2,155.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$402.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,716.71
|
| 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 |
$1,466.68
|
| Rate for Payer: Blue Distinction Transplant |
$1,437.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,480.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,163.97
|
| Rate for Payer: Caremore Medicare Advantage |
$402.12
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,916.00
|
| Rate for Payer: Cigna of CA HMO |
$1,532.80
|
| Rate for Payer: Cigna of CA PPO |
$1,772.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.18
|
| Rate for Payer: Dignity Health Media |
$402.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$402.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$402.12
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,155.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,796.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$659.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$663.50
|
| 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 |
$1,597.46
|
| 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 |
$479.00
|
| 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 |
$1,796.25
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
| 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 |
$1,437.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,437.00
|
| 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: 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 HI-RES MOLECULAR
|
Facility
|
OP
|
$2,330.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,323.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,431.70
|
| 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 |
$3,323.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,132.38
|
| Rate for Payer: Caremore Medicare Advantage |
$335.38
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,864.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.20
|
| Rate for Payer: Cigna of CA PPO |
$1,724.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Media |
$335.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.38
|
| Rate for Payer: Galaxy Health WC |
$1,980.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,097.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,747.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$553.38
|
| 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 |
$1,554.11
|
| 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 |
$466.00
|
| 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 |
$1,747.50
|
| Rate for Payer: Networks By Design Commercial |
$1,514.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,980.50
|
| 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 |
$1,398.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,398.00
|
| 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: 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 HI-RES MOLECULAR
|
Facility
|
IP
|
$2,330.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$466.00 |
| Max. Negotiated Rate |
$2,097.00 |
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$932.00
|
| Rate for Payer: Galaxy Health WC |
$1,980.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,097.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$887.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.00
|
| Rate for Payer: Multiplan Commercial |
$1,747.50
|
| Rate for Payer: Networks By Design Commercial |
$1,514.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,980.50
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$283.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$64.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.97
|
| Rate for Payer: Blue Distinction Transplant |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$56.86
|
| Rate for Payer: Blue Shield of California EPN |
$44.71
|
| Rate for Payer: Caremore Medicare Advantage |
$64.19
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.28
|
| Rate for Payer: Dignity Health Media |
$64.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.19
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.19
|
| Rate for Payer: InnovAge PACE Commercial |
$96.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.01
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Medicare |
$68.04
|
| Rate for Payer: Riverside University Health System MISP |
$70.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.99
|
| Rate for Payer: United Healthcare All Other HMO |
$51.99
|
| Rate for Payer: United Healthcare HMO Rider |
$51.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Vantage Medical Group Senior |
$64.19
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,147.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$850.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$956.25
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$3,167.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$403.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,761.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,596.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,167.30
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$250.29
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Caremore Medicare Advantage |
$403.59
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.38
|
| Rate for Payer: Dignity Health Media |
$403.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$403.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$403.59
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$661.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$665.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$403.59
|
| Rate for Payer: InnovAge PACE Commercial |
$605.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$540.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$540.81
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Prime Health Services Medicare |
$427.81
|
| Rate for Payer: Riverside University Health System MISP |
$443.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.91
|
| Rate for Payer: United Healthcare All Other HMO |
$326.91
|
| Rate for Payer: United Healthcare HMO Rider |
$326.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Vantage Medical Group Senior |
$403.59
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$514.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$58.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$300.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$421.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.54
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$137.20
|
| Rate for Payer: Blue Shield of California EPN |
$107.89
|
| Rate for Payer: Caremore Medicare Advantage |
$58.00
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Media |
$58.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$58.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$95.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: InnovAge PACE Commercial |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Medicare |
$61.48
|
| Rate for Payer: Riverside University Health System MISP |
$63.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO |
$46.98
|
| Rate for Payer: United Healthcare HMO Rider |
$46.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Central Health Plan Commercial |
$805.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.80
|
| Rate for Payer: Galaxy Health WC |
$855.95
|
| Rate for Payer: Global Benefits Group Commercial |
$604.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$906.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
| Rate for Payer: Networks By Design Commercial |
$654.55
|
| Rate for Payer: Prime Health Services Commercial |
$855.95
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$177.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.90
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$137.20
|
| Rate for Payer: Blue Shield of California EPN |
$107.89
|
| Rate for Payer: Caremore Medicare Advantage |
$177.25
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Media |
$177.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$177.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$292.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: InnovAge PACE Commercial |
$265.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.52
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Medicare |
$187.88
|
| Rate for Payer: Riverside University Health System MISP |
$194.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA - B27
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903901903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
|
|
HC HLA - B27
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903901903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$1,072.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$127.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$878.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.09
|
| Rate for Payer: Blue Distinction Transplant |
$85.20
|
| Rate for Payer: Blue Shield of California Commercial |
$87.76
|
| Rate for Payer: Blue Shield of California EPN |
$69.01
|
| Rate for Payer: Caremore Medicare Advantage |
$127.43
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.14
|
| Rate for Payer: Dignity Health Media |
$127.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$127.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.43
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$106.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$210.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: InnovAge PACE Commercial |
$191.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$135.08
|
| Rate for Payer: Riverside University Health System MISP |
$140.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA B MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Central Health Plan Commercial |
$805.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.80
|
| Rate for Payer: Galaxy Health WC |
$855.95
|
| Rate for Payer: Global Benefits Group Commercial |
$604.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$906.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
| Rate for Payer: Networks By Design Commercial |
$654.55
|
| Rate for Payer: Prime Health Services Commercial |
$855.95
|
|
|
HC HLA B MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$177.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.90
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$137.20
|
| Rate for Payer: Blue Shield of California EPN |
$107.89
|
| Rate for Payer: Caremore Medicare Advantage |
$177.25
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Media |
$177.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$177.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$292.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: InnovAge PACE Commercial |
$265.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.52
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Medicare |
$187.88
|
| Rate for Payer: Riverside University Health System MISP |
$194.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA CELL STORAGE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901971
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$50.68
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC HLA CELL STORAGE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901971
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC HLA C MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Central Health Plan Commercial |
$805.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.80
|
| Rate for Payer: Galaxy Health WC |
$855.95
|
| Rate for Payer: Global Benefits Group Commercial |
$604.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$906.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
| Rate for Payer: Networks By Design Commercial |
$654.55
|
| Rate for Payer: Prime Health Services Commercial |
$855.95
|
|
|
HC HLA C MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$177.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.90
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$137.20
|
| Rate for Payer: Blue Shield of California EPN |
$107.89
|
| Rate for Payer: Caremore Medicare Advantage |
$177.25
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Media |
$177.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$177.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$292.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: InnovAge PACE Commercial |
$265.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.52
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Medicare |
$187.88
|
| Rate for Payer: Riverside University Health System MISP |
$194.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA-DP MOLECULAR
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903902017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
|
