|
HC SOM HEMOSIDERIN, URINE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$28.05 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
HC SOM HEMOSIDERIN, URINE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$48.99 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$15.21
|
| Rate for Payer: Blue Shield of California Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
|
OP
|
$43.68
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$160.87 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.87
|
| Rate for Payer: Blue Shield of California Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.44
|
| Rate for Payer: Cash Price |
$43.68
|
| Rate for Payer: Cash Price |
$43.68
|
| Rate for Payer: Cigna of CA HMO |
$27.96
|
| Rate for Payer: Cigna of CA PPO |
$32.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.31
|
| Rate for Payer: EPIC Health Plan Senior |
$20.21
|
| Rate for Payer: Galaxy Health WC |
$37.13
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$28.39
|
| Rate for Payer: Prime Health Services Commercial |
$37.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
|
IP
|
$43.68
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$43.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.47
|
| Rate for Payer: EPIC Health Plan Senior |
$17.47
|
| Rate for Payer: Galaxy Health WC |
$37.13
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$28.39
|
| Rate for Payer: Prime Health Services Commercial |
$37.13
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$31.35
|
| Rate for Payer: Blue Shield of California Commercial |
$47.40
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
|
OP
|
$16.43
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$115.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.22
|
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7.57
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO |
$10.52
|
| Rate for Payer: Cigna of CA PPO |
$12.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$12.73
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$10.68
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.37
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare HMO Rider |
$9.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
|
IP
|
$16.43
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: EPIC Health Plan Senior |
$6.57
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$10.68
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$166.29 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.29
|
| Rate for Payer: Blue Shield of California Commercial |
$27.66
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.31
|
| Rate for Payer: EPIC Health Plan Senior |
$18.88
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.90
|
| Rate for Payer: United Healthcare All Other HMO |
$13.90
|
| Rate for Payer: United Healthcare HMO Rider |
$13.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Vantage Medical Group Senior |
$17.16
|
|
|
HC SOM HHEMO 81256
|
Facility
|
OP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$555.91 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| 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 |
$32.72
|
| Rate for Payer: Blue Shield of California Commercial |
$49.47
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Cigna of CA HMO |
$45.43
|
| Rate for Payer: Cigna of CA PPO |
$52.53
|
| 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 |
$49.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.84
|
| Rate for Payer: EPIC Health Plan Senior |
$71.90
|
| Rate for Payer: Galaxy Health WC |
$60.33
|
| Rate for Payer: Global Benefits Group Commercial |
$42.59
|
| 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 |
$45.07
|
| 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 |
$17.04
|
| 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 |
$56.78
|
| Rate for Payer: Networks By Design Commercial |
$46.14
|
| Rate for Payer: Prime Health Services Commercial |
$60.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.59
|
| 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 HMO Rider |
$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 HHEMO 81256
|
Facility
|
IP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$60.33 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.39
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| Rate for Payer: Galaxy Health WC |
$60.33
|
| Rate for Payer: Global Benefits Group Commercial |
$42.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.78
|
| Rate for Payer: Networks By Design Commercial |
$46.14
|
| Rate for Payer: Prime Health Services Commercial |
$60.33
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.78
|
| Rate for Payer: Blue Shield of California Commercial |
$55.32
|
| Rate for Payer: Blue Shield of California Commercial |
$83.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.72
|
| Rate for Payer: EPIC Health Plan Senior |
$32.48
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.57
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.92
|
| Rate for Payer: United Healthcare All Other HMO |
$23.92
|
| Rate for Payer: United Healthcare HMO Rider |
$23.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$29.53
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR1
|
Facility
|
OP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$103.24
|
| Rate for Payer: Blue Shield of California Commercial |
$68.28
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna of CA HMO |
$94.80
|
| Rate for Payer: Cigna of CA PPO |
$109.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$125.90
|
| Rate for Payer: Global Benefits Group Commercial |
$88.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| 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 |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.87
|
| 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 HISTOPLAS BLASTOMYC PCR1
|
Facility
|
IP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$125.90 |
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.25
|
| Rate for Payer: EPIC Health Plan Senior |
$59.25
|
| Rate for Payer: Galaxy Health WC |
$125.90
|
| Rate for Payer: Global Benefits Group Commercial |
$88.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.90
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
OP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$103.25
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cigna of CA HMO |
$94.80
|
| Rate for Payer: Cigna of CA PPO |
$109.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$125.91
|
| Rate for Payer: Global Benefits Group Commercial |
$88.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| 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 |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.88
|
| 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 HISTOPLAS BLASTOMYC PCR2
|
Facility
|
IP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$125.91 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.25
|
| Rate for Payer: EPIC Health Plan Senior |
$59.25
|
| Rate for Payer: Galaxy Health WC |
$125.91
|
| Rate for Payer: Global Benefits Group Commercial |
$88.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.91
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$130.29 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.03
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$15.17
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$11.17
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$118.49
|
| Rate for Payer: Blue Shield of California Commercial |
$78.37
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| 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 |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| 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 HIV-1 ANTIBODY
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.90
|
| Rate for Payer: EPIC Health Plan Senior |
$11.90
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.81
|
| Rate for Payer: Networks By Design Commercial |
$19.34
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
HC SOM HIV-1 ANTIBODY
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$91.66 |
| Rate for Payer: Cigna of CA PPO |
$22.02
|
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.66
|
| Rate for Payer: Blue Shield of California Commercial |
$13.72
|
| Rate for Payer: Blue Shield of California Commercial |
$20.74
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cigna of CA HMO |
$19.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Senior |
$9.78
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$23.81
|
| Rate for Payer: Networks By Design Commercial |
$19.34
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
IP
|
$441.82
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.36 |
| Max. Negotiated Rate |
$375.55 |
| Rate for Payer: Adventist Health Commercial |
$88.36
|
| Rate for Payer: Cash Price |
$441.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.73
|
| Rate for Payer: EPIC Health Plan Senior |
$176.73
|
| Rate for Payer: Galaxy Health WC |
$375.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.04
|
| Rate for Payer: Multiplan Commercial |
$353.46
|
| Rate for Payer: Networks By Design Commercial |
$287.18
|
| Rate for Payer: Prime Health Services Commercial |
$375.55
|
|
