|
HC HLA C MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$1,107.24 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| 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 Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Blue Shield of California Commercial |
$453.62
|
| Rate for Payer: Blue Shield of California Commercial |
$100.04
|
| Rate for Payer: Blue Shield of California Commercial |
$685.85
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| 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 All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$820.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$762.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.08
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: Networks By Design Commercial |
$839.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 81830
|
| Hospital Charge Code |
900913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.60
|
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$561.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$549.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.28
|
| Rate for Payer: Blue Shield of California Commercial |
$596.63
|
| Rate for Payer: Blue Shield of California Commercial |
$131.73
|
| Rate for Payer: Blue Shield of California Commercial |
$87.13
|
| Rate for Payer: Blue Shield of California Commercial |
$394.62
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA HMO |
$547.84
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Cigna of CA PPO |
$633.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$599.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$599.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$684.80
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.00
|
| Rate for Payer: United Healthcare All Other HMO |
$428.00
|
| Rate for Payer: United Healthcare All Other HMO |
$94.50
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$1,247.05 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$676.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$676.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.05
|
| Rate for Payer: Blue Shield of California Commercial |
$204.68
|
| Rate for Payer: Blue Shield of California Commercial |
$595.61
|
| Rate for Payer: Blue Shield of California Commercial |
$309.47
|
| Rate for Payer: Blue Shield of California Commercial |
$900.52
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA HMO |
$826.88
|
| Rate for Payer: Cigna of CA PPO |
$956.08
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$904.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.26
|
| Rate for Payer: EPIC Health Plan Senior |
$140.17
|
| Rate for Payer: EPIC Health Plan Senior |
$140.17
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$820.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Networks By Design Commercial |
$839.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$775.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$775.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$127.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$127.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 81830
|
| Hospital Charge Code |
900913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$727.60 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.44
|
| Rate for Payer: Multiplan Commercial |
$684.80
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
|
|
HC HLA DISEASE ASSOCIATION 81376 CLASS II
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| 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 Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Blue Shield of California Commercial |
$204.68
|
| Rate for Payer: Blue Shield of California Commercial |
$614.97
|
| Rate for Payer: Blue Shield of California Commercial |
$309.47
|
| Rate for Payer: Blue Shield of California Commercial |
$929.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| 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 All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| 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 Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DISEASE ASSOCIATION 81376 CLASS II
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$787.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC HLA-DP MOLECULAR
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903902017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$869.31 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| 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 Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Blue Shield of California Commercial |
$319.93
|
| Rate for Payer: Blue Shield of California Commercial |
$111.10
|
| Rate for Payer: Blue Shield of California Commercial |
$483.72
|
| Rate for Payer: Blue Shield of California Commercial |
$167.98
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO |
$444.16
|
| Rate for Payer: Cigna of CA HMO |
$154.24
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Cigna of CA PPO |
$513.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| 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 All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| 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 Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA-DP MOLECULAR
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903902017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
|
|
HC HLA-DP MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903902018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.98 |
| Max. Negotiated Rate |
$564.18 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Adventist Health Commercial |
$178.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.18
|
| Rate for Payer: Blue Shield of California Commercial |
$412.13
|
| Rate for Payer: Blue Shield of California Commercial |
$269.69
|
| Rate for Payer: Blue Shield of California Commercial |
$623.12
|
| Rate for Payer: Blue Shield of California Commercial |
$407.75
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$409.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.13
|
| Rate for Payer: EPIC Health Plan Senior |
$116.75
|
| Rate for Payer: EPIC Health Plan Senior |
$116.75
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$174.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$371.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.23
|
| Rate for Payer: Multiplan Commercial |
$715.20
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$536.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| 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 All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| 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 Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC HLA-DP MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903902018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$759.90 |
| Rate for Payer: Adventist Health Commercial |
$178.80
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: EPIC Health Plan Senior |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$527.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.56
|
| Rate for Payer: Multiplan Commercial |
$715.20
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| 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 Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Blue Shield of California Commercial |
$235.11
|
| Rate for Payer: Blue Shield of California Commercial |
$567.49
|
| Rate for Payer: Blue Shield of California Commercial |
$355.47
|
| Rate for Payer: Blue Shield of California Commercial |
$858.01
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cigna of CA HMO |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Cigna of CA PPO |
$377.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Galaxy Health WC |
$433.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Global Benefits Group Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$306.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| 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 All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| 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 Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$613.20
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$904.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| 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 Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Blue Shield of California Commercial |
$100.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,068.50
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Blue Shield of California Commercial |
$706.71
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA HMO |
$981.12
|
| Rate for Payer: Cigna of CA PPO |
$1,134.42
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$919.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| 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 All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| 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 Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$1,365.95 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| 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 |
$1,365.95
|
| Rate for Payer: Blue Shield of California Commercial |
$497.88
|
| Rate for Payer: Blue Shield of California Commercial |
$752.76
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna of CA HMO |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$799.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$331.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.22
|
| Rate for Payer: EPIC Health Plan Senior |
$242.81
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$362.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$220.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| 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 |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$648.00
|
| 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: Upland Medical Group Pediatric |
$220.74
|
| 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 MOLECULAR
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.98 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| 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 |
$564.18
|
| Rate for Payer: Blue Shield of California Commercial |
$341.60
|
| Rate for Payer: Blue Shield of California Commercial |
$516.48
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.13
|
| Rate for Payer: EPIC Health Plan Senior |
$116.75
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| 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 |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| 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: Upland Medical Group Pediatric |
$106.14
|
| 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
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.16
|
| 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 Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.57
|
| Rate for Payer: Blue Shield of California Commercial |
$235.11
|
| Rate for Payer: Blue Shield of California Commercial |
$567.49
|
| Rate for Payer: Blue Shield of California Commercial |
$355.47
|
| Rate for Payer: Blue Shield of California Commercial |
$858.01
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cigna of CA HMO |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Cigna of CA PPO |
$377.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Galaxy Health WC |
$433.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Global Benefits Group Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$306.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| 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 All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| 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 Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$613.20
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$904.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| 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 Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Blue Shield of California Commercial |
$100.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,068.50
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Blue Shield of California Commercial |
$706.71
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA HMO |
$981.12
|
| Rate for Payer: Cigna of CA PPO |
$1,134.42
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$919.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| 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 All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| 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 Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| 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 Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Blue Shield of California Commercial |
$131.73
|
| Rate for Payer: Blue Shield of California Commercial |
$614.97
|
| Rate for Payer: Blue Shield of California Commercial |
$87.13
|
| Rate for Payer: Blue Shield of California Commercial |
$929.80
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| 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 All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$787.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
