|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$104.93 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$7.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.86
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
IP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Senior |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.32
|
| Rate for Payer: Global Benefits Group Commercial |
$152.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.08
|
| Rate for Payer: Multiplan Commercial |
$203.60
|
| Rate for Payer: Networks By Design Commercial |
$165.43
|
| Rate for Payer: Prime Health Services Commercial |
$216.32
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
OP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$216.32 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$177.39
|
| Rate for Payer: Blue Shield of California Commercial |
$117.32
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna of CA HMO |
$162.88
|
| Rate for Payer: Cigna of CA PPO |
$188.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Senior |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.32
|
| Rate for Payer: Global Benefits Group Commercial |
$152.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.15
|
| Rate for Payer: Multiplan Commercial |
$203.60
|
| Rate for Payer: Networks By Design Commercial |
$165.43
|
| Rate for Payer: Prime Health Services Commercial |
$216.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.32
|
| Rate for Payer: Vantage Medical Group Senior |
$216.32
|
|
|
HC SOM BCR/ABL1, P190, MRNA DETECTION, RT-PCR, QUANTITATIVE, MONITORING ASSAY
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
900915426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$339.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
|
HC SOM BCR/ABL1, P190, MRNA DETECTION, RT-PCR, QUANTITATIVE, MONITORING ASSAY
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
900915426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$416.86 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.86
|
| Rate for Payer: Blue Shield of California Commercial |
$223.59
|
| Rate for Payer: Blue Shield of California Commercial |
$338.05
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna of CA HMO |
$310.40
|
| Rate for Payer: Cigna of CA PPO |
$358.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$339.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.99
|
| Rate for Payer: EPIC Health Plan Senior |
$159.32
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.09
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.32
|
| Rate for Payer: United Healthcare All Other HMO |
$117.32
|
| Rate for Payer: United Healthcare HMO Rider |
$117.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.32
|
| Rate for Payer: Vantage Medical Group Senior |
$144.84
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
OP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$1,544.67 |
| Rate for Payer: Cigna of CA PPO |
$321.96
|
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$417.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,544.67
|
| Rate for Payer: Blue Shield of California Commercial |
$200.57
|
| Rate for Payer: Blue Shield of California Commercial |
$303.25
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Cigna of CA HMO |
$278.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.58
|
| Rate for Payer: EPIC Health Plan Senior |
$203.72
|
| Rate for Payer: Galaxy Health WC |
$369.82
|
| Rate for Payer: Global Benefits Group Commercial |
$261.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$348.06
|
| Rate for Payer: Networks By Design Commercial |
$282.80
|
| Rate for Payer: Prime Health Services Commercial |
$369.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
IP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$369.82 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.03
|
| Rate for Payer: EPIC Health Plan Senior |
$174.03
|
| Rate for Payer: Galaxy Health WC |
$369.82
|
| Rate for Payer: Global Benefits Group Commercial |
$261.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.42
|
| Rate for Payer: Multiplan Commercial |
$348.06
|
| Rate for Payer: Networks By Design Commercial |
$282.80
|
| Rate for Payer: Prime Health Services Commercial |
$369.82
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM BCR/ABL P210 QN MON
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$416.86 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.86
|
| Rate for Payer: Blue Shield of California Commercial |
$139.40
|
| Rate for Payer: Blue Shield of California Commercial |
$92.20
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.53
|
| Rate for Payer: EPIC Health Plan Senior |
$180.36
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$229.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.71
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.80
|
| Rate for Payer: United Healthcare All Other HMO |
$132.80
|
| Rate for Payer: United Healthcare HMO Rider |
$132.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Vantage Medical Group Senior |
$163.96
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
OP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$183.10 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.04
|
| Rate for Payer: Blue Shield of California Commercial |
$25.76
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cigna of CA HMO |
$23.65
|
| Rate for Payer: Cigna of CA PPO |
$27.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.78
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$31.42
|
| Rate for Payer: Global Benefits Group Commercial |
$22.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.87
|
| Rate for Payer: Multiplan Commercial |
$29.57
|
| Rate for Payer: Networks By Design Commercial |
$24.02
|
| Rate for Payer: Prime Health Services Commercial |
$31.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.48
|
| Rate for Payer: United Healthcare All Other HMO |
$18.48
|
| Rate for Payer: United Healthcare HMO Rider |
$18.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.42
|
| Rate for Payer: Vantage Medical Group Senior |
$31.42
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
IP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$31.42 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.78
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$31.42
|
| Rate for Payer: Global Benefits Group Commercial |
$22.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$29.57
|
| Rate for Payer: Networks By Design Commercial |
$24.02
|
| Rate for Payer: Prime Health Services Commercial |
$31.42
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.33
|
| Rate for Payer: EPIC Health Plan Senior |
$22.33
|
| Rate for Payer: Galaxy Health WC |
$47.46
|
| Rate for Payer: Global Benefits Group Commercial |
$33.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$44.66
|
| Rate for Payer: Networks By Design Commercial |
$36.29
|
| Rate for Payer: Prime Health Services Commercial |
$47.46
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
OP
|
$55.83
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.05
|
| Rate for Payer: Blue Shield of California Commercial |
$25.74
|
| Rate for Payer: Blue Shield of California Commercial |
$38.91
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cigna of CA HMO |
$35.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: EPIC Health Plan Senior |
$17.80
|
| Rate for Payer: Galaxy Health WC |
$47.46
|
| Rate for Payer: Global Benefits Group Commercial |
$33.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$44.66
|
| Rate for Payer: Networks By Design Commercial |
$36.29
|
| Rate for Payer: Prime Health Services Commercial |
$47.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.10
|
| Rate for Payer: United Healthcare All Other HMO |
$13.10
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.05
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.25
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: EPIC Health Plan Senior |
$17.80
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.10
|
| Rate for Payer: United Healthcare All Other HMO |
$13.10
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.05
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: EPIC Health Plan Senior |
$17.80
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.10
|
| Rate for Payer: United Healthcare All Other HMO |
$13.10
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
OP
|
$85.98
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$244.09 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.63
|
| Rate for Payer: Blue Shield of California Commercial |
$39.64
|
| Rate for Payer: Blue Shield of California Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Cigna of CA HMO |
$55.03
|
| Rate for Payer: Cigna of CA PPO |
$63.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.43
|
| Rate for Payer: EPIC Health Plan Senior |
$32.28
|
| Rate for Payer: Galaxy Health WC |
$73.08
|
| Rate for Payer: Global Benefits Group Commercial |
$51.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$68.78
|
| Rate for Payer: Networks By Design Commercial |
$55.89
|
| Rate for Payer: Prime Health Services Commercial |
$73.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.78
|
| Rate for Payer: United Healthcare All Other HMO |
$23.78
|
| Rate for Payer: United Healthcare HMO Rider |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
IP
|
$85.98
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Galaxy Health WC |
$73.08
|
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.39
|
| Rate for Payer: EPIC Health Plan Senior |
$34.39
|
| Rate for Payer: Global Benefits Group Commercial |
$51.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.78
|
| Rate for Payer: Networks By Design Commercial |
$55.89
|
| Rate for Payer: Prime Health Services Commercial |
$73.08
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
OP
|
$119.58
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$23.92
|
| 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 |
$55.13
|
| Rate for Payer: Blue Shield of California Commercial |
$83.35
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Cigna of CA HMO |
$76.53
|
| Rate for Payer: Cigna of CA PPO |
$88.49
|
| 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 |
$83.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$101.64
|
| Rate for Payer: Global Benefits Group Commercial |
$71.75
|
| 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 |
$75.93
|
| 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 |
$28.70
|
| 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 |
$95.66
|
| Rate for Payer: Networks By Design Commercial |
$77.73
|
| Rate for Payer: Prime Health Services Commercial |
$101.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.75
|
| 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 BETA GALACTOSIDASE
|
Facility
|
IP
|
$119.58
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Adventist Health Commercial |
$23.92
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.83
|
| Rate for Payer: EPIC Health Plan Senior |
$47.83
|
| Rate for Payer: Galaxy Health WC |
$101.64
|
| Rate for Payer: Global Benefits Group Commercial |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$95.66
|
| Rate for Payer: Networks By Design Commercial |
$77.73
|
| Rate for Payer: Prime Health Services Commercial |
$101.64
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGA
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$262.46 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.46
|
| 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 |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| 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 |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| 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 |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGA
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| 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 BETA GLYCOPROTEIN AB IGG
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.41
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.82
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGG
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$262.46 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.46
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Blue Shield of California Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna of CA HMO |
$23.05
|
| Rate for Payer: Cigna of CA PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$28.82
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
