|
HC SOM MYCOPHENOLIC ACID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
900910761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.26
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.05
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900911589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Networks By Design Commercial |
$6.76
|
| Rate for Payer: Prime Health Services Commercial |
$8.84
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900911589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.60
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$6.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Networks By Design Commercial |
$6.76
|
| Rate for Payer: Prime Health Services Commercial |
$8.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGM
|
Facility
|
OP
|
$10.41
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900912639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.60
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGM
|
Facility
|
IP
|
$10.41
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900912639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
|
|
HC SOM MYCOPLASMA PNEUMON IGA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SOM MYCOPLASMA PNEUMON IGA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM MYCO PNEUM DNA PCR
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900914442
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM MYCO PNEUM DNA PCR
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900914442
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$117.08
|
| Rate for Payer: Blue Shield of California EPN |
$77.35
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM MYELOID NEOPLASM NGS
|
Facility
|
OP
|
$1,989.23
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
900915522
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.85 |
| Max. Negotiated Rate |
$21,268.00 |
| Rate for Payer: Adventist Health Commercial |
$397.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,304.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$835.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,268.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,330.79
|
| Rate for Payer: Blue Shield of California EPN |
$879.24
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Cigna of CA HMO |
$1,273.11
|
| Rate for Payer: Cigna of CA PPO |
$1,472.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$835.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$759.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.37
|
| Rate for Payer: EPIC Health Plan Senior |
$759.53
|
| Rate for Payer: Galaxy Health WC |
$1,690.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,193.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,245.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$759.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$759.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$957.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,017.77
|
| Rate for Payer: Multiplan Commercial |
$1,591.38
|
| Rate for Payer: Networks By Design Commercial |
$1,293.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,690.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,193.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,193.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$615.22
|
| Rate for Payer: United Healthcare All Other HMO |
$615.22
|
| Rate for Payer: United Healthcare HMO Rider |
$615.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$615.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$759.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$835.48
|
| Rate for Payer: Vantage Medical Group Senior |
$759.53
|
|
|
HC SOM MYELOID NEOPLASM NGS
|
Facility
|
IP
|
$1,989.23
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
900915522
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.85 |
| Max. Negotiated Rate |
$1,690.85 |
| Rate for Payer: Adventist Health Commercial |
$397.85
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.69
|
| Rate for Payer: EPIC Health Plan Senior |
$795.69
|
| Rate for Payer: Galaxy Health WC |
$1,690.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,193.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,231.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.42
|
| Rate for Payer: Multiplan Commercial |
$1,591.38
|
| Rate for Payer: Networks By Design Commercial |
$1,293.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,690.85
|
|
|
HC SOM MYELOPEROXIDASE
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900910578
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$5.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$18.67
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$17.86
|
| Rate for Payer: Cigna of CA PPO |
$20.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$23.71
|
| Rate for Payer: Global Benefits Group Commercial |
$16.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: Networks By Design Commercial |
$18.14
|
| Rate for Payer: Prime Health Services Commercial |
$23.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM MYELOPEROXIDASE
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900910578
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Adventist Health Commercial |
$5.58
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.16
|
| Rate for Payer: EPIC Health Plan Senior |
$11.16
|
| Rate for Payer: Galaxy Health WC |
$23.71
|
| Rate for Payer: Global Benefits Group Commercial |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: Networks By Design Commercial |
$18.14
|
| Rate for Payer: Prime Health Services Commercial |
$23.71
|
|
|
HC SOM MYOGLOBINURIA PROFILE
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914702
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC SOM MYOGLOBINURIA PROFILE
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914702
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.34
|
| Rate for Payer: Blue Shield of California Commercial |
$585.38
|
| Rate for Payer: Blue Shield of California EPN |
$386.75
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC SOM MYOGLOBIN URINE
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC SOM MYOGLOBIN URINE
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$127.94 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.94
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.44
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO |
$10.47
|
| Rate for Payer: United Healthcare HMO Rider |
$10.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC SOM MYOMARKER3 NONANTIBODY
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.61
|
| Rate for Payer: EPIC Health Plan Senior |
$67.61
|
| Rate for Payer: Galaxy Health WC |
$143.67
|
| Rate for Payer: Global Benefits Group Commercial |
$101.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$135.22
|
| Rate for Payer: Networks By Design Commercial |
$109.86
|
| Rate for Payer: Prime Health Services Commercial |
$143.67
|
|
|
HC SOM MYOMARKER3 NONANTIBODY
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$113.07
|
| Rate for Payer: Blue Shield of California EPN |
$74.71
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Cigna of CA HMO |
$108.17
|
| Rate for Payer: Cigna of CA PPO |
$125.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$143.67
|
| Rate for Payer: Global Benefits Group Commercial |
$101.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$135.22
|
| Rate for Payer: Networks By Design Commercial |
$109.86
|
| Rate for Payer: Prime Health Services Commercial |
$143.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
IP
|
$183.98
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$183.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.59
|
| Rate for Payer: EPIC Health Plan Senior |
$73.59
|
| Rate for Payer: Galaxy Health WC |
$156.38
|
| Rate for Payer: Global Benefits Group Commercial |
$110.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.18
|
| Rate for Payer: Networks By Design Commercial |
$119.59
|
| Rate for Payer: Prime Health Services Commercial |
$156.38
|
|
|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
OP
|
$183.98
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$156.38 |
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$156.38
|
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.42
|
| Rate for Payer: Blue Shield of California Commercial |
$123.08
|
| Rate for Payer: Blue Shield of California EPN |
$81.32
|
| Rate for Payer: Cash Price |
$183.98
|
| Rate for Payer: Cash Price |
$183.98
|
| Rate for Payer: Cigna of CA HMO |
$117.75
|
| Rate for Payer: Cigna of CA PPO |
$136.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: Global Benefits Group Commercial |
$110.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$147.18
|
| Rate for Payer: Networks By Design Commercial |
$119.59
|
| Rate for Payer: Prime Health Services Commercial |
$156.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SOM NEOPTERIN
|
Facility
|
IP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$152.36 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.70
|
| Rate for Payer: EPIC Health Plan Senior |
$71.70
|
| Rate for Payer: Galaxy Health WC |
$152.36
|
| Rate for Payer: Global Benefits Group Commercial |
$107.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.02
|
| Rate for Payer: Multiplan Commercial |
$143.40
|
| Rate for Payer: Networks By Design Commercial |
$116.51
|
| Rate for Payer: Prime Health Services Commercial |
$152.36
|
|
|
HC SOM NEOPTERIN
|
Facility
|
OP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$152.36 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$119.92
|
| Rate for Payer: Blue Shield of California EPN |
$79.23
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cigna of CA HMO |
$114.72
|
| Rate for Payer: Cigna of CA PPO |
$132.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$152.36
|
| Rate for Payer: Global Benefits Group Commercial |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$143.40
|
| Rate for Payer: Networks By Design Commercial |
$116.51
|
| Rate for Payer: Prime Health Services Commercial |
$152.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
