|
HC SOM ALDOSTERONE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| 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
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$420.69 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.92
|
| 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 |
$420.69
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.24
|
| Rate for Payer: EPIC Health Plan Senior |
$44.83
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| 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 |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| 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
|
$54.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.44
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.64
|
| 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 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 |
$152.67 |
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.05
|
| 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 |
$152.67
|
| Rate for Payer: Blue Shield of California Commercial |
$11.39
|
| Rate for Payer: Blue Shield of California Commercial |
$7.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.39
|
| Rate for Payer: EPIC Health Plan Senior |
$16.26
|
| Rate for Payer: Galaxy Health WC |
$13.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$10.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.69
|
| 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
|
|
|
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 |
$53.37 |
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| 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 |
$53.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.01
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.38
|
| 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
|
OP
|
$13.61
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$138.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.72
|
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| 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 |
$138.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.49
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cigna of CA HMO |
$8.71
|
| Rate for Payer: Cigna of CA PPO |
$10.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| 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 |
$10.89
|
| Rate for Payer: Networks By Design Commercial |
$8.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.17
|
| 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 PHENO A1AT
|
Facility
|
IP
|
$13.61
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Adventist Health Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Senior |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$10.89
|
| Rate for Payer: Networks By Design Commercial |
$8.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
OP
|
$14.64
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.27
|
| 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 |
$149.19
|
| Rate for Payer: Blue Shield of California Commercial |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cigna of CA HMO |
$9.37
|
| Rate for Payer: Cigna of CA PPO |
$10.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$12.44
|
| Rate for Payer: Global Benefits Group Commercial |
$8.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| 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 |
$11.71
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$12.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.78
|
| 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 PHENOTYPE
|
Facility
|
IP
|
$14.64
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$12.44 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$12.44
|
| Rate for Payer: Global Benefits Group Commercial |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$12.44
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$138.56 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.72
|
| 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 |
$138.56
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.18
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| 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 |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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-2-MACROGLOBULIN
|
Facility
|
OP
|
$26.07
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$140.51 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.04
|
| 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 |
$140.51
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California Commercial |
$18.17
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cigna of CA HMO |
$16.68
|
| Rate for Payer: Cigna of CA PPO |
$19.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.44
|
| Rate for Payer: EPIC Health Plan Senior |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$22.16
|
| Rate for Payer: Global Benefits Group Commercial |
$15.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.26
|
| 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 |
$20.86
|
| Rate for Payer: Networks By Design Commercial |
$16.95
|
| Rate for Payer: Prime Health Services Commercial |
$22.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.64
|
| 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-2-MACROGLOBULIN
|
Facility
|
IP
|
$26.07
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.43
|
| Rate for Payer: EPIC Health Plan Senior |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$22.16
|
| Rate for Payer: Global Benefits Group Commercial |
$15.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$20.86
|
| Rate for Payer: Networks By Design Commercial |
$16.95
|
| Rate for Payer: Prime Health Services Commercial |
$22.16
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$173.17 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.53
|
| 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 |
$173.17
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.05
|
| Rate for Payer: EPIC Health Plan Senior |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| 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 |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| 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 CSF
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 FETOPROTEIN CSF
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$214.79 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.79
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| 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 |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| 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 |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$149.85
|
| Rate for Payer: Blue Shield of California Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC SOM ALUMINUM
|
Facility
|
OP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$263.02 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.93
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cigna of CA HMO |
$12.79
|
| Rate for Payer: Cigna of CA PPO |
$14.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.04
|
| Rate for Payer: EPIC Health Plan Senior |
$28.03
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.14
|
| Rate for Payer: Multiplan Commercial |
$15.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.64
|
| Rate for Payer: United Healthcare All Other HMO |
$20.64
|
| Rate for Payer: United Healthcare HMO Rider |
$20.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Vantage Medical Group Senior |
$25.48
|
|
|
HC SOM ALUMINUM
|
Facility
|
IP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$16.99 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$15.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
OP
|
$31.86
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$126.61 |
| Rate for Payer: Adventist Health Commercial |
$6.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.61
|
| Rate for Payer: Blue Shield of California Commercial |
$14.69
|
| Rate for Payer: Blue Shield of California Commercial |
$22.21
|
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Cigna of CA HMO |
$20.39
|
| Rate for Payer: Cigna of CA PPO |
$23.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.44
|
| Rate for Payer: EPIC Health Plan Senior |
$13.63
|
| Rate for Payer: Galaxy Health WC |
$27.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$25.49
|
| Rate for Payer: Networks By Design Commercial |
$20.71
|
| Rate for Payer: Prime Health Services Commercial |
$27.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.04
|
| Rate for Payer: United Healthcare All Other HMO |
$10.04
|
| Rate for Payer: United Healthcare HMO Rider |
$10.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
IP
|
$31.86
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$27.08 |
| Rate for Payer: Adventist Health Commercial |
$6.37
|
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Senior |
$12.74
|
| Rate for Payer: Galaxy Health WC |
$27.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$25.49
|
| Rate for Payer: Networks By Design Commercial |
$20.71
|
| Rate for Payer: Prime Health Services Commercial |
$27.08
|
|
