|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
IP
|
$16.34
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$14.71 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Central Health Plan Commercial |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$13.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: Networks By Design Commercial |
$10.62
|
| Rate for Payer: Prime Health Services Commercial |
$13.89
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
IP
|
$5.73
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Central Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2.29
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$4.87
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
OP
|
$5.73
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Central Health Plan Commercial |
$4.58
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$4.87
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$97.66 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$10.22
|
| Rate for Payer: Cigna of CA HMO |
$8.17
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: InnovAge PACE Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Medicare |
$14.25
|
| Rate for Payer: Riverside University Health System MISP |
$14.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.11
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$105.15 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$10.22
|
| Rate for Payer: Cigna of CA HMO |
$8.17
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$10.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.46
|
| Rate for Payer: InnovAge PACE Commercial |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$8.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.46
|
| Rate for Payer: Prime Health Services Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Medicare |
$15.33
|
| Rate for Payer: Riverside University Health System MISP |
$15.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Vantage Medical Group Senior |
$14.46
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$97.66 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: InnovAge PACE Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.25
|
| Rate for Payer: Riverside University Health System MISP |
$14.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$99.03 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.10
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: InnovAge PACE Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.60
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.42
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$122.05 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Senior |
$17.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.00
|
| Rate for Payer: InnovAge PACE Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.78
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$18.02
|
| Rate for Payer: Riverside University Health System MISP |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO |
$13.77
|
| Rate for Payer: United Healthcare HMO Rider |
$13.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$151.39 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.72
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| 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 |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: InnovAge PACE Commercial |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| 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 |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$151.75
|
| Rate for Payer: Blue Shield of California EPN |
$99.25
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$160.00
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: InnovAge PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM ALUMINUM
|
Facility
|
IP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Central Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
|
|
HC SOM ALUMINUM
|
Facility
|
OP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$185.38 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.62
|
| Rate for Payer: Blue Shield of California Commercial |
$12.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Central Health Plan Commercial |
$15.99
|
| Rate for Payer: Cigna of CA HMO |
$12.79
|
| Rate for Payer: Cigna of CA PPO |
$14.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$25.48
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.48
|
| Rate for Payer: InnovAge PACE Commercial |
$38.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.14
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
| Rate for Payer: Prime Health Services Medicare |
$27.01
|
| Rate for Payer: Riverside University Health System MISP |
$28.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.64
|
| Rate for Payer: United Healthcare All Other HMO |
$20.64
|
| Rate for Payer: United Healthcare HMO Rider |
$20.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Vantage Medical Group Senior |
$25.48
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: InnovAge PACE Commercial |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.39
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$13.13
|
| Rate for Payer: Riverside University Health System MISP |
$13.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.04
|
| Rate for Payer: United Healthcare All Other HMO |
$10.04
|
| Rate for Payer: United Healthcare HMO Rider |
$10.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$122.15 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.79
|
| Rate for Payer: Blue Shield of California Commercial |
$60.70
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: InnovAge PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$122.15 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.79
|
| Rate for Payer: Blue Shield of California Commercial |
$45.52
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: InnovAge PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
