|
HC SOM AFP & TOTAL AFT, SERUM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
900913812
|
|
Hospital Revenue Code
|
301
|
| 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 AFP & TOTAL AFT, SERUM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
900913812
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$622.35 |
| 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 |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.35
|
| 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 |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.95
|
| Rate for Payer: EPIC Health Plan Senior |
$64.41
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.31
|
| 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 |
$52.17
|
| Rate for Payer: United Healthcare All Other HMO |
$52.17
|
| Rate for Payer: United Healthcare HMO Rider |
$52.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM ALBUMIN LEVEL BODY FLUID
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: EPIC Health Plan Senior |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM ALBUMIN LEVEL BODY FLUID
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM ALDOLASE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
900910218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$95.89 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$5.76
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC SOM ALDOLASE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
900910218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
HC SOM ALDOSTERONE
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$402.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.57
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.62
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna of CA HMO |
$12.48
|
| Rate for Payer: Cigna of CA PPO |
$14.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.01
|
| Rate for Payer: EPIC Health Plan Senior |
$40.75
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$15.60
|
| Rate for Payer: Networks By Design Commercial |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.01
|
| Rate for Payer: United Healthcare All Other HMO |
$33.01
|
| Rate for Payer: United Healthcare HMO Rider |
$33.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$40.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Vantage Medical Group Senior |
$40.75
|
|
|
HC SOM ALDOSTERONE
|
Facility
|
IP
|
$19.50
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.80
|
| Rate for Payer: Galaxy Health WC |
$16.57
|
| Rate for Payer: Global Benefits Group Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$15.60
|
| Rate for Payer: Networks By Design Commercial |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$402.57 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.57
|
| Rate for Payer: Blue Shield of California Commercial |
$30.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.01
|
| Rate for Payer: EPIC Health Plan Senior |
$40.75
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.01
|
| Rate for Payer: United Healthcare All Other HMO |
$33.01
|
| Rate for Payer: United Healthcare HMO Rider |
$33.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$40.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.83
|
| Rate for Payer: Vantage Medical Group Senior |
$40.75
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
OP
|
$16.34
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$146.09 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.09
|
| Rate for Payer: Blue Shield of California Commercial |
$10.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.22
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cigna of CA HMO |
$10.46
|
| Rate for Payer: Cigna of CA PPO |
$12.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.95
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$13.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$13.07
|
| Rate for Payer: Networks By Design Commercial |
$10.62
|
| Rate for Payer: Prime Health Services Commercial |
$13.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
IP
|
$16.34
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$13.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$13.07
|
| Rate for Payer: Networks By Design Commercial |
$10.62
|
| Rate for Payer: Prime Health Services Commercial |
$13.89
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
OP
|
$5.73
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$4.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
IP
|
$5.73
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2.29
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$4.87
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.64
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cigna of CA HMO |
$8.17
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$142.77 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.64
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cigna of CA HMO |
$8.17
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$10.22
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Vantage Medical Group Senior |
$14.46
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$134.46 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.46
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$165.71 |
| 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 |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.71
|
| 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 |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Senior |
$17.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.78
|
| 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 |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO |
$13.77
|
| Rate for Payer: United Healthcare HMO Rider |
$13.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| 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
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
