|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.28
|
| Rate for Payer: Blue Shield of California Commercial |
$23.41
|
| Rate for Payer: Blue Shield of California EPN |
$15.47
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| 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 |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$139.40 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Senior |
$65.60
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.36
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$109.72
|
| Rate for Payer: Blue Shield of California EPN |
$72.49
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna of CA HMO |
$104.96
|
| Rate for Payer: Cigna of CA PPO |
$121.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
OP
|
$41.20
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$165.84 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.84
|
| Rate for Payer: Blue Shield of California Commercial |
$27.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.21
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cigna of CA HMO |
$26.37
|
| Rate for Payer: Cigna of CA PPO |
$30.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$32.96
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
IP
|
$41.20
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$35.02 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.48
|
| Rate for Payer: EPIC Health Plan Senior |
$16.48
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$32.96
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
|
|
HC SOM ACYLGLYCINE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$117.08
|
| Rate for Payer: Blue Shield of California EPN |
$77.35
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM ACYLGLYCINE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$139.58 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$80.28
|
| Rate for Payer: Blue Shield of California EPN |
$53.04
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Senior |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$80.28
|
| Rate for Payer: Blue Shield of California EPN |
$53.04
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$113.73
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Senior |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$64.09
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM ADENOVIRUS DNA PCR
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.63
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ADENOVIRUS DNA PCR
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM ADENOVIRUS DNA PCR NON-BLOOD
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900910713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.63
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ADENOVIRUS DNA PCR NON-BLOOD
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900910713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM ADENOVIRUS DNA PCR QUANT
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM ADENOVIRUS DNA PCR QUANT
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$55.25
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM AF CULT GENE TEST CELLS
|
Facility
|
OP
|
$210.92
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915286
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: Adventist Health Commercial |
$42.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.55
|
| Rate for Payer: Blue Shield of California Commercial |
$141.11
|
| Rate for Payer: Blue Shield of California EPN |
$93.23
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna of CA HMO |
$134.99
|
| Rate for Payer: Cigna of CA PPO |
$156.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$179.28
|
| Rate for Payer: Global Benefits Group Commercial |
$126.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$137.10
|
| Rate for Payer: Prime Health Services Commercial |
$179.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM AF CULT GENE TEST CELLS
|
Facility
|
IP
|
$210.92
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915286
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$179.28 |
| Rate for Payer: Adventist Health Commercial |
$42.18
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.37
|
| Rate for Payer: EPIC Health Plan Senior |
$84.37
|
| Rate for Payer: Galaxy Health WC |
$179.28
|
| Rate for Payer: Global Benefits Group Commercial |
$126.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.62
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$137.10
|
| Rate for Payer: Prime Health Services Commercial |
$179.28
|
|
|
HC SOM AF CULT GENE TEST CRYO
|
Facility
|
OP
|
$14.46
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$10.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$13.07
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC SOM AF CULT GENE TEST CRYO
|
Facility
|
IP
|
$14.46
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
|
