|
HC SOM MUR 85549
|
Facility
|
OP
|
$26.87
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900914739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Adventist Health Commercial |
$5.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.39
|
| Rate for Payer: Blue Shield of California Commercial |
$18.73
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Cigna of CA HMO |
$17.20
|
| Rate for Payer: Cigna of CA PPO |
$19.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.94
|
| Rate for Payer: EPIC Health Plan Senior |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$22.84
|
| Rate for Payer: Global Benefits Group Commercial |
$16.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$21.50
|
| Rate for Payer: Networks By Design Commercial |
$17.47
|
| Rate for Payer: Prime Health Services Commercial |
$22.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.19
|
| Rate for Payer: United Healthcare HMO Rider |
$15.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC SOM MURAMIDASE SERUM
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900911063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC SOM MURAMIDASE SERUM
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900911063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.94
|
| Rate for Payer: EPIC Health Plan Senior |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.19
|
| Rate for Payer: United Healthcare HMO Rider |
$15.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC SOM MUSK AUTOANTIBODY
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
900915423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$262.50
|
| Rate for Payer: United Healthcare HMO Rider |
$262.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.44
|
| Rate for Payer: Blue Shield of California Commercial |
$365.93
|
| Rate for Payer: Blue Shield of California Commercial |
$242.03
|
|
|
HC SOM MUSK AUTOANTIBODY
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
900915423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC SOM MYCOPHENOLIC ACID
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
900910761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM MYCOPHENOLIC ACID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
900910761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$145.58 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.09
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.86
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGG
|
Facility
|
IP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900911589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$9.55
|
| Rate for Payer: Networks By Design Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$10.15
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGG
|
Facility
|
OP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900911589
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$8.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$10.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$9.55
|
| Rate for Payer: Networks By Design Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$10.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGM
|
Facility
|
OP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900912639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$8.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$10.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$9.55
|
| Rate for Payer: Networks By Design Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$10.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM MYCOPLASMA PNEUMONIAE AB IGM
|
Facility
|
IP
|
$11.94
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900912639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$9.55
|
| Rate for Payer: Networks By Design Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$10.15
|
|
|
HC SOM MYCOPLASMA PNEUMON IGA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SOM MYCOPLASMA PNEUMON IGA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$57.15
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM MYCO PNEUM DNA PCR
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900914442
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM MYCO PNEUM DNA PCR
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900914442
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| 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 |
$121.97
|
| Rate for Payer: Blue Shield of California Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM MYELOID NEOPLASM NGS
|
Facility
|
IP
|
$1,989.23
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
900915522
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.85 |
| Max. Negotiated Rate |
$1,690.85 |
| Rate for Payer: Adventist Health Commercial |
$397.85
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,392.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.69
|
| Rate for Payer: EPIC Health Plan Senior |
$795.69
|
| Rate for Payer: Galaxy Health WC |
$1,690.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,263.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,173.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.42
|
| Rate for Payer: Multiplan Commercial |
$1,591.38
|
| Rate for Payer: Networks By Design Commercial |
$1,293.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,690.85
|
|
|
HC SOM MYELOID NEOPLASM NGS
|
Facility
|
OP
|
$1,989.23
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
900915522
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.85 |
| Max. Negotiated Rate |
$22,224.94 |
| Rate for Payer: Adventist Health Commercial |
$397.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,999.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$835.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,224.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,386.49
|
| Rate for Payer: Blue Shield of California Commercial |
$917.04
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Cash Price |
$1,989.23
|
| Rate for Payer: Cigna of CA HMO |
$1,273.11
|
| Rate for Payer: Cigna of CA PPO |
$1,472.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$835.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$759.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,392.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,253.22
|
| Rate for Payer: EPIC Health Plan Senior |
$835.48
|
| Rate for Payer: Galaxy Health WC |
$1,690.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,193.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,245.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$759.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,263.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,063.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$957.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,017.77
|
| Rate for Payer: Multiplan Commercial |
$1,591.38
|
| Rate for Payer: Networks By Design Commercial |
$1,293.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,690.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,193.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,193.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$615.22
|
| Rate for Payer: United Healthcare All Other HMO |
$615.22
|
| Rate for Payer: United Healthcare HMO Rider |
$615.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$615.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$759.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$835.48
|
| Rate for Payer: Vantage Medical Group Senior |
$759.53
|
|
|
HC SOM MYELOPEROXIDASE
|
Facility
|
OP
|
$30.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900910578
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Adventist Health Commercial |
$6.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$14.18
|
| Rate for Payer: Blue Shield of California Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Cigna of CA HMO |
$19.68
|
| Rate for Payer: Cigna of CA PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$26.14
|
| Rate for Payer: Global Benefits Group Commercial |
$18.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$24.60
|
| Rate for Payer: Networks By Design Commercial |
$19.99
|
| Rate for Payer: Prime Health Services Commercial |
$26.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM MYELOPEROXIDASE
|
Facility
|
IP
|
$30.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900910578
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Adventist Health Commercial |
$6.15
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.30
|
| Rate for Payer: EPIC Health Plan Senior |
$12.30
|
| Rate for Payer: Galaxy Health WC |
$26.14
|
| Rate for Payer: Global Benefits Group Commercial |
$18.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$24.60
|
| Rate for Payer: Networks By Design Commercial |
$19.99
|
| Rate for Payer: Prime Health Services Commercial |
$26.14
|
|
|
HC SOM MYOGLOBINURIA PROFILE
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914702
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC SOM MYOGLOBINURIA PROFILE
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914702
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.49
|
| Rate for Payer: Blue Shield of California Commercial |
$403.38
|
| Rate for Payer: Blue Shield of California Commercial |
$609.88
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC SOM MYOGLOBIN URINE
|
Facility
|
OP
|
$20.21
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$133.70 |
| Rate for Payer: Galaxy Health WC |
$17.18
|
| Rate for Payer: Adventist Health Commercial |
$4.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.70
|
| Rate for Payer: Blue Shield of California Commercial |
$14.09
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cigna of CA HMO |
$12.93
|
| Rate for Payer: Cigna of CA PPO |
$14.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$14.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$16.17
|
| Rate for Payer: Networks By Design Commercial |
$13.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO |
$10.47
|
| Rate for Payer: United Healthcare HMO Rider |
$10.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC SOM MYOGLOBIN URINE
|
Facility
|
IP
|
$20.21
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Adventist Health Commercial |
$4.04
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.18
|
| Rate for Payer: Global Benefits Group Commercial |
$12.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$16.17
|
| Rate for Payer: Networks By Design Commercial |
$13.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.18
|
|
|
HC SOM MYOMARKER3 NONANTIBODY
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$14.37 |
| Rate for Payer: Adventist Health Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.76
|
| Rate for Payer: EPIC Health Plan Senior |
$6.76
|
| Rate for Payer: Galaxy Health WC |
$14.37
|
| Rate for Payer: Global Benefits Group Commercial |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$13.52
|
| Rate for Payer: Networks By Design Commercial |
$10.98
|
| Rate for Payer: Prime Health Services Commercial |
$14.37
|
|
|
HC SOM MYOMARKER3 NONANTIBODY
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Adventist Health Commercial |
$3.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.78
|
| Rate for Payer: Blue Shield of California Commercial |
$7.79
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cash Price |
$16.90
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$14.37
|
| Rate for Payer: Global Benefits Group Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$13.52
|
| Rate for Payer: Networks By Design Commercial |
$10.98
|
| Rate for Payer: Prime Health Services Commercial |
$14.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
