|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SODIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.16
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Media |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM STOOL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.16
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Media |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$44.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.35
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Media |
$5.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SOFT PALATE
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,187.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$286.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.33
|
| Rate for Payer: Blue Distinction Transplant |
$838.20
|
| Rate for Payer: Blue Shield of California Commercial |
$825.63
|
| Rate for Payer: Blue Shield of California EPN |
$655.19
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cigna of CA HMO |
$894.08
|
| Rate for Payer: Cigna of CA PPO |
$1,033.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,047.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$838.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$838.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SOFT PALATE
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.28 |
| Max. Negotiated Rate |
$1,187.45 |
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
|
|
HC SOLUBLE FIBRIN
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.50
|
| Rate for Payer: Blue Distinction Transplant |
$51.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.52
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: Dignity Health Media |
$80.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$80.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.46
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$131.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$130.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.82
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.17
|
| Rate for Payer: United Healthcare All Other HMO |
$65.17
|
| Rate for Payer: United Healthcare HMO Rider |
$65.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
|
HC SOM 18-OH CORTICOSTERONE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
HC SOM 18-OH CORTICOSTERONE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$164.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.06
|
| Rate for Payer: Blue Distinction Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.17
|
| Rate for Payer: Blue Shield of California EPN |
$86.53
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Media |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$39.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$267.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.01
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15.50
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| 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 |
$43.92
|
| Rate for Payer: Dignity Health Media |
$29.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$47.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| 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 |
$23.72
|
| Rate for Payer: United Healthcare All Other HMO |
$23.72
|
| Rate for Payer: United Healthcare HMO Rider |
$23.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| 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 ANTI-SMOOTH MUSCLE
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$68.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.54
|
| Rate for Payer: Blue Distinction Transplant |
$7.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.60
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA PPO |
$9.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$10.96
|
| Rate for Payer: Global Benefits Group Commercial |
$7.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Prime Health Services Commercial |
$10.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.16
|
| Rate for Payer: Galaxy Health WC |
$10.96
|
| Rate for Payer: Global Benefits Group Commercial |
$7.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Prime Health Services Commercial |
$10.96
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$173.07 |
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.44
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.87
|
| Rate for Payer: Multiplan Commercial |
$162.89
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$288.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$271.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.69
|
| Rate for Payer: Blue Distinction Transplant |
$122.17
|
| Rate for Payer: Blue Shield of California Commercial |
$131.53
|
| Rate for Payer: Blue Shield of California EPN |
$104.25
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Cigna of CA HMO |
$130.31
|
| Rate for Payer: Cigna of CA PPO |
$150.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Media |
$137.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$152.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$221.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$162.89
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Media |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Cash Price |
$74.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.88
|
| Rate for Payer: Galaxy Health WC |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$98.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.53
|
| Rate for Payer: Multiplan Commercial |
$131.76
|
| Rate for Payer: Networks By Design Commercial |
$107.06
|
| Rate for Payer: Prime Health Services Commercial |
$140.00
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.29
|
| Rate for Payer: Blue Distinction Transplant |
$98.82
|
| Rate for Payer: Blue Shield of California Commercial |
$106.40
|
| Rate for Payer: Blue Shield of California EPN |
$84.33
|
| Rate for Payer: Cash Price |
$74.12
|
| Rate for Payer: Cash Price |
$74.12
|
| Rate for Payer: Cigna of CA HMO |
$105.41
|
| Rate for Payer: Cigna of CA PPO |
$121.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$98.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$131.76
|
| Rate for Payer: Networks By Design Commercial |
$107.06
|
| Rate for Payer: Prime Health Services Commercial |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
OP
|
$342.30
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$290.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.66
|
| Rate for Payer: Blue Distinction Transplant |
$205.38
|
| Rate for Payer: Blue Shield of California Commercial |
$221.13
|
| Rate for Payer: Blue Shield of California EPN |
$175.26
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Cigna of CA HMO |
$219.07
|
| Rate for Payer: Cigna of CA PPO |
$253.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Media |
$18.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.06
|
| Rate for Payer: Galaxy Health WC |
$290.96
|
| Rate for Payer: Global Benefits Group Commercial |
$205.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$256.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$273.84
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$290.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.38
|
| 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: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
IP
|
$342.30
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.15 |
| Max. Negotiated Rate |
$290.96 |
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.92
|
| Rate for Payer: Galaxy Health WC |
$290.96
|
| Rate for Payer: Global Benefits Group Commercial |
$205.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.15
|
| Rate for Payer: Multiplan Commercial |
$273.84
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$290.96
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
IP
|
$280.10
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Cash Price |
$126.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.04
|
| Rate for Payer: Galaxy Health WC |
$238.08
|
| Rate for Payer: Global Benefits Group Commercial |
$168.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.22
|
| Rate for Payer: Multiplan Commercial |
$224.08
|
| Rate for Payer: Networks By Design Commercial |
$182.06
|
| Rate for Payer: Prime Health Services Commercial |
$238.08
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
OP
|
$280.10
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.85
|
| Rate for Payer: Blue Distinction Transplant |
$168.06
|
| Rate for Payer: Blue Shield of California Commercial |
$180.94
|
| Rate for Payer: Blue Shield of California EPN |
$143.41
|
| Rate for Payer: Cash Price |
$126.05
|
| Rate for Payer: Cash Price |
$126.05
|
| Rate for Payer: Cigna of CA HMO |
$179.26
|
| Rate for Payer: Cigna of CA PPO |
$207.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.08
|
| Rate for Payer: Dignity Health Media |
$238.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.04
|
| Rate for Payer: Galaxy Health WC |
$238.08
|
| Rate for Payer: Global Benefits Group Commercial |
$168.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.22
|
| Rate for Payer: Multiplan Commercial |
$224.08
|
| Rate for Payer: Networks By Design Commercial |
$182.06
|
| Rate for Payer: Prime Health Services Commercial |
$238.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.05
|
| Rate for Payer: United Healthcare All Other HMO |
$140.05
|
| Rate for Payer: United Healthcare HMO Rider |
$140.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.08
|
| Rate for Payer: Vantage Medical Group Senior |
$238.08
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
IP
|
$107.03
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$90.98 |
| Rate for Payer: Cash Price |
$48.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.81
|
| Rate for Payer: Galaxy Health WC |
$90.98
|
| Rate for Payer: Global Benefits Group Commercial |
$64.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.69
|
| Rate for Payer: Multiplan Commercial |
$85.62
|
| Rate for Payer: Networks By Design Commercial |
$69.57
|
| Rate for Payer: Prime Health Services Commercial |
$90.98
|
|
