|
HC SOM GLUCAGON
|
Facility
|
IP
|
$45.20
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Adventist Health Commercial |
$9.04
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.08
|
| Rate for Payer: EPIC Health Plan Senior |
$18.08
|
| Rate for Payer: Galaxy Health WC |
$38.42
|
| Rate for Payer: Global Benefits Group Commercial |
$27.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$36.16
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Commercial |
$38.42
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
OP
|
$31.80
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Cigna of CA PPO |
$23.53
|
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.06
|
| Rate for Payer: Blue Shield of California Commercial |
$14.66
|
| Rate for Payer: Blue Shield of California Commercial |
$22.16
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna of CA HMO |
$20.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.67
|
| Rate for Payer: Galaxy Health WC |
$27.03
|
| Rate for Payer: Global Benefits Group Commercial |
$19.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$25.44
|
| Rate for Payer: Networks By Design Commercial |
$20.67
|
| Rate for Payer: Prime Health Services Commercial |
$27.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Vantage Medical Group Senior |
$9.70
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
IP
|
$31.80
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Senior |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.03
|
| Rate for Payer: Global Benefits Group Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$25.44
|
| Rate for Payer: Networks By Design Commercial |
$20.67
|
| Rate for Payer: Prime Health Services Commercial |
$27.03
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$24.57
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: Adventist Health Commercial |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California Commercial |
$17.13
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cigna of CA HMO |
$15.72
|
| Rate for Payer: Cigna of CA PPO |
$18.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$20.88
|
| Rate for Payer: Global Benefits Group Commercial |
$14.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$19.66
|
| Rate for Payer: Networks By Design Commercial |
$15.97
|
| Rate for Payer: Prime Health Services Commercial |
$20.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$20.88 |
| Rate for Payer: Adventist Health Commercial |
$4.91
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.83
|
| Rate for Payer: EPIC Health Plan Senior |
$9.83
|
| Rate for Payer: Galaxy Health WC |
$20.88
|
| Rate for Payer: Global Benefits Group Commercial |
$14.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$19.66
|
| Rate for Payer: Networks By Design Commercial |
$15.97
|
| Rate for Payer: Prime Health Services Commercial |
$20.88
|
|
|
HC SOM GROWTH HORMONE
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$171.99 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.99
|
| Rate for Payer: Blue Shield of California Commercial |
$4.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.53
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$6.91
|
| Rate for Payer: Cigna of CA PPO |
$7.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.51
|
| Rate for Payer: EPIC Health Plan Senior |
$18.34
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.34
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Vantage Medical Group Senior |
$16.67
|
|
|
HC SOM GROWTH HORMONE
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
|
IP
|
$56.38
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$47.92 |
| Rate for Payer: Adventist Health Commercial |
$11.28
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.55
|
| Rate for Payer: EPIC Health Plan Senior |
$22.55
|
| Rate for Payer: Galaxy Health WC |
$47.92
|
| Rate for Payer: Global Benefits Group Commercial |
$33.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$45.10
|
| Rate for Payer: Networks By Design Commercial |
$36.65
|
| Rate for Payer: Prime Health Services Commercial |
$47.92
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
|
OP
|
$56.38
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$150.17 |
| Rate for Payer: Adventist Health Commercial |
$11.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.17
|
| Rate for Payer: Blue Shield of California Commercial |
$25.99
|
| Rate for Payer: Blue Shield of California Commercial |
$39.30
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cigna of CA HMO |
$36.08
|
| Rate for Payer: Cigna of CA PPO |
$41.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.04
|
| Rate for Payer: EPIC Health Plan Senior |
$17.36
|
| Rate for Payer: Galaxy Health WC |
$47.92
|
| Rate for Payer: Global Benefits Group Commercial |
$33.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$45.10
|
| Rate for Payer: Networks By Design Commercial |
$36.65
|
| Rate for Payer: Prime Health Services Commercial |
$47.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.78
|
| Rate for Payer: United Healthcare All Other HMO |
$12.78
|
| Rate for Payer: United Healthcare HMO Rider |
$12.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Vantage Medical Group Senior |
$15.78
|
|
|
HC SOM HANDLING FEE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM HANDLING FEE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.25
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
|
|
HC SOM HBEL ELECTROPHORESIS SUMMARY INTERP
|
Facility
|
OP
|
$77.25
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$112.85 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Blue Shield of California Commercial |
$35.61
|
| Rate for Payer: Blue Shield of California Commercial |
$53.84
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cigna of CA HMO |
$49.44
|
| Rate for Payer: Cigna of CA PPO |
$57.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$65.66
|
| Rate for Payer: Global Benefits Group Commercial |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$61.80
|
| Rate for Payer: Networks By Design Commercial |
$50.21
|
| Rate for Payer: Prime Health Services Commercial |
$65.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM HBEL ELECTROPHORESIS SUMMARY INTERP
|
Facility
|
IP
|
$77.25
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$65.66 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.90
|
| Rate for Payer: EPIC Health Plan Senior |
$30.90
|
| Rate for Payer: Galaxy Health WC |
$65.66
|
| Rate for Payer: Global Benefits Group Commercial |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.54
|
| Rate for Payer: Multiplan Commercial |
$61.80
|
| Rate for Payer: Networks By Design Commercial |
$50.21
|
| Rate for Payer: Prime Health Services Commercial |
$65.66
|
|
|
HC SOM HBEL VARIANT, A2 AND F QUANTITATION,B
|
Facility
|
IP
|
$12.56
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$10.68 |
| Rate for Payer: Adventist Health Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.02
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$10.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.01
|
| Rate for Payer: Multiplan Commercial |
$10.05
|
| Rate for Payer: Networks By Design Commercial |
$8.16
|
| Rate for Payer: Prime Health Services Commercial |
$10.68
|
|
|
HC SOM HBEL VARIANT, A2 AND F QUANTITATION,B
|
Facility
|
OP
|
$12.56
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$112.85 |
| Rate for Payer: Cigna of CA PPO |
$9.29
|
| Rate for Payer: Adventist Health Commercial |
$2.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.85
|
| Rate for Payer: Blue Shield of California Commercial |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8.75
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$10.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$10.05
|
| Rate for Payer: Networks By Design Commercial |
$8.16
|
| Rate for Payer: Prime Health Services Commercial |
$10.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM HBEL VARIANT B
|
Facility
|
OP
|
$17.62
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
900915459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$3.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8.12
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Cigna of CA HMO |
$11.28
|
| Rate for Payer: Cigna of CA PPO |
$13.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.87
|
| Rate for Payer: Galaxy Health WC |
$14.98
|
| Rate for Payer: Global Benefits Group Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$14.10
|
| Rate for Payer: Networks By Design Commercial |
$11.45
|
| Rate for Payer: Prime Health Services Commercial |
$14.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.57
|
| 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 |
$18.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM HBEL VARIANT B
|
Facility
|
IP
|
$17.62
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
900915459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$17.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.05
|
| Rate for Payer: Galaxy Health WC |
$14.98
|
| Rate for Payer: Global Benefits Group Commercial |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$14.10
|
| Rate for Payer: Networks By Design Commercial |
$11.45
|
| Rate for Payer: Prime Health Services Commercial |
$14.98
|
|
|
HC SOM HCG HIGH SENSITIVITY
|
Facility
|
OP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$148.71 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.71
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$7.73
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cigna of CA HMO |
$10.73
|
| Rate for Payer: Cigna of CA PPO |
$12.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$14.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$10.90
|
| Rate for Payer: Prime Health Services Commercial |
$14.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM HCG HIGH SENSITIVITY
|
Facility
|
IP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.71
|
| Rate for Payer: EPIC Health Plan Senior |
$6.71
|
| Rate for Payer: Galaxy Health WC |
$14.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$10.90
|
| Rate for Payer: Prime Health Services Commercial |
$14.25
|
|
|
HC SOM HCV GENOTYPING
|
Facility
|
IP
|
$140.69
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$119.59 |
| Rate for Payer: Adventist Health Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$140.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.28
|
| Rate for Payer: EPIC Health Plan Senior |
$56.28
|
| Rate for Payer: Galaxy Health WC |
$119.59
|
| Rate for Payer: Global Benefits Group Commercial |
$84.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$112.55
|
| Rate for Payer: Networks By Design Commercial |
$91.45
|
| Rate for Payer: Prime Health Services Commercial |
$119.59
|
|
|
HC SOM HCV GENOTYPING
|
Facility
|
OP
|
$140.69
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$2,655.52 |
| Rate for Payer: Adventist Health Commercial |
$28.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,140.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,655.52
|
| Rate for Payer: Blue Shield of California Commercial |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$98.06
|
| Rate for Payer: Cash Price |
$140.69
|
| Rate for Payer: Cash Price |
$140.69
|
| Rate for Payer: Cigna of CA HMO |
$90.04
|
| Rate for Payer: Cigna of CA PPO |
$104.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.79
|
| Rate for Payer: EPIC Health Plan Senior |
$283.19
|
| Rate for Payer: Galaxy Health WC |
$119.59
|
| Rate for Payer: Global Benefits Group Commercial |
$84.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$422.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$384.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$434.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$112.55
|
| Rate for Payer: Networks By Design Commercial |
$91.45
|
| Rate for Payer: Prime Health Services Commercial |
$119.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.54
|
| Rate for Payer: United Healthcare All Other HMO |
$208.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$257.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM HEMO A INV INTERP
|
Facility
|
OP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$1,544.67 |
| Rate for Payer: Adventist Health Commercial |
$110.61
|
| 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 |
$254.96
|
| Rate for Payer: Blue Shield of California Commercial |
$385.48
|
| Rate for Payer: Cash Price |
$553.05
|
| Rate for Payer: Cash Price |
$553.05
|
| Rate for Payer: Cigna of CA HMO |
$353.95
|
| Rate for Payer: Cigna of CA PPO |
$409.26
|
| 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 |
$387.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.58
|
| Rate for Payer: EPIC Health Plan Senior |
$203.72
|
| Rate for Payer: Galaxy Health WC |
$470.09
|
| Rate for Payer: Global Benefits Group Commercial |
$331.83
|
| 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 |
$351.19
|
| 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 |
$132.73
|
| 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 |
$442.44
|
| Rate for Payer: Networks By Design Commercial |
$359.48
|
| Rate for Payer: Prime Health Services Commercial |
$470.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.83
|
| 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 HEMO A INV INTERP
|
Facility
|
IP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$470.09 |
| Rate for Payer: Adventist Health Commercial |
$110.61
|
| Rate for Payer: Cash Price |
$553.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.22
|
| Rate for Payer: EPIC Health Plan Senior |
$221.22
|
| Rate for Payer: Galaxy Health WC |
$470.09
|
| Rate for Payer: Global Benefits Group Commercial |
$331.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.73
|
| Rate for Payer: Multiplan Commercial |
$442.44
|
| Rate for Payer: Networks By Design Commercial |
$359.48
|
| Rate for Payer: Prime Health Services Commercial |
$470.09
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
|
OP
|
$178.63
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$555.91 |
| Rate for Payer: United Healthcare HMO Rider |
$52.94
|
| Rate for Payer: Adventist Health Commercial |
$35.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$555.91
|
| Rate for Payer: Blue Shield of California Commercial |
$124.51
|
| Rate for Payer: Blue Shield of California Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$178.63
|
| Rate for Payer: Cash Price |
$178.63
|
| Rate for Payer: Cigna of CA HMO |
$114.32
|
| Rate for Payer: Cigna of CA PPO |
$132.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.84
|
| Rate for Payer: EPIC Health Plan Senior |
$71.90
|
| Rate for Payer: Galaxy Health WC |
$151.84
|
| Rate for Payer: Global Benefits Group Commercial |
$107.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.58
|
| Rate for Payer: Multiplan Commercial |
$142.90
|
| Rate for Payer: Networks By Design Commercial |
$116.11
|
| Rate for Payer: Prime Health Services Commercial |
$151.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.94
|
| Rate for Payer: United Healthcare All Other HMO |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
|
IP
|
$178.63
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$151.84 |
| Rate for Payer: Adventist Health Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$178.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.45
|
| Rate for Payer: EPIC Health Plan Senior |
$71.45
|
| Rate for Payer: Galaxy Health WC |
$151.84
|
| Rate for Payer: Global Benefits Group Commercial |
$107.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.87
|
| Rate for Payer: Multiplan Commercial |
$142.90
|
| Rate for Payer: Networks By Design Commercial |
$116.11
|
| Rate for Payer: Prime Health Services Commercial |
$151.84
|
|
