|
HC HLA CELL STORAGE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901971
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: 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 HLA CELL STORAGE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901971
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California EPN |
$41.98
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| 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
|
| 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 |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC HLA C MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$978.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.73
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Media |
$177.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$177.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.52
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA C MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$241.68 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.80
|
| Rate for Payer: Galaxy Health WC |
$855.95
|
| Rate for Payer: Global Benefits Group Commercial |
$604.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.68
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: Networks By Design Commercial |
$654.55
|
| Rate for Payer: Prime Health Services Commercial |
$855.95
|
|
|
HC HLA-DP MOLECULAR
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903902017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$768.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$768.41
|
| Rate for Payer: Blue Distinction Transplant |
$147.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.92
|
| Rate for Payer: Blue Shield of California EPN |
$125.95
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Media |
$123.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$123.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Heritage Provider Network Transplant |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$200.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA-DP MOLECULAR
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903902017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$603.50 |
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
|
|
HC HLA-DP MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903902018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$535.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$535.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.70
|
| Rate for Payer: Blue Distinction Transplant |
$191.40
|
| Rate for Payer: Blue Shield of California Commercial |
$206.07
|
| Rate for Payer: Blue Shield of California EPN |
$163.33
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO |
$204.16
|
| Rate for Payer: Cigna of CA PPO |
$236.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Media |
$106.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$106.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.14
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$171.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.23
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| Rate for Payer: United Healthcare All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC HLA-DP MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903902018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.24 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.40
|
| Rate for Payer: Galaxy Health WC |
$574.60
|
| Rate for Payer: Global Benefits Group Commercial |
$405.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.24
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: Networks By Design Commercial |
$439.40
|
| Rate for Payer: Prime Health Services Commercial |
$574.60
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$689.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$689.98
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Media |
$122.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$122.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.44
|
| Rate for Payer: Heritage Provider Network Transplant |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$302.16 |
| Max. Negotiated Rate |
$1,070.15 |
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.60
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.16
|
| Rate for Payer: Multiplan Commercial |
$1,007.20
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$768.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$768.41
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Media |
$123.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$123.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Heritage Provider Network Transplant |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$200.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$1,207.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$746.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$331.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,207.41
|
| Rate for Payer: Blue Distinction Transplant |
$282.00
|
| Rate for Payer: Blue Shield of California Commercial |
$303.62
|
| Rate for Payer: Blue Shield of California EPN |
$240.64
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$331.11
|
| Rate for Payer: Dignity Health Media |
$220.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$220.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.74
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$352.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$362.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$357.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$357.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$220.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.79
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other HMO |
$178.80
|
| Rate for Payer: United Healthcare HMO Rider |
$178.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$331.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.81
|
| Rate for Payer: Vantage Medical Group Senior |
$220.74
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.98 |
| Max. Negotiated Rate |
$535.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$535.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.70
|
| Rate for Payer: Blue Distinction Transplant |
$336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$361.76
|
| Rate for Payer: Blue Shield of California EPN |
$286.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Media |
$106.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$106.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.14
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$420.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$171.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.23
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| Rate for Payer: United Healthcare All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$302.16 |
| Max. Negotiated Rate |
$1,070.15 |
| Rate for Payer: Cash Price |
$566.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.60
|
| Rate for Payer: Galaxy Health WC |
$1,070.15
|
| Rate for Payer: Global Benefits Group Commercial |
$755.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.16
|
| Rate for Payer: Multiplan Commercial |
$1,007.20
|
| Rate for Payer: Networks By Design Commercial |
$818.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,070.15
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$689.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$689.98
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Media |
$122.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$122.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.44
|
| Rate for Payer: Heritage Provider Network Transplant |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$768.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$768.41
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Media |
$123.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$123.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Heritage Provider Network Transplant |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$200.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.00
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| 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 HLA X MATCH AUTO
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$667.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$667.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.22
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$147.29
|
| Rate for Payer: Blue Shield of California EPN |
$116.74
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Media |
$109.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$109.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.49
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$177.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$400.40
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$676.00
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
