|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
IP
|
$174.77
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$157.29 |
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Central Health Plan Commercial |
$139.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.91
|
| Rate for Payer: Galaxy Health WC |
$148.55
|
| Rate for Payer: Global Benefits Group Commercial |
$104.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.95
|
| Rate for Payer: Multiplan Commercial |
$131.08
|
| Rate for Payer: Networks By Design Commercial |
$113.60
|
| Rate for Payer: Prime Health Services Commercial |
$148.55
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
OP
|
$174.77
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$157.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.85
|
| Rate for Payer: BCBS Transplant Transplant |
$104.86
|
| Rate for Payer: Blue Shield of California Commercial |
$108.01
|
| Rate for Payer: Blue Shield of California EPN |
$84.94
|
| Rate for Payer: Caremore Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Central Health Plan Commercial |
$139.82
|
| Rate for Payer: Cigna of CA HMO |
$111.85
|
| Rate for Payer: Cigna of CA PPO |
$129.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.66
|
| Rate for Payer: Galaxy Health WC |
$148.55
|
| Rate for Payer: Global Benefits Group Commercial |
$104.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$131.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.84
|
| Rate for Payer: IEHP medi-cal |
$15.94
|
| Rate for Payer: IEHP Medicare Advantage |
$9.66
|
| Rate for Payer: Innovage PACE Commercial |
$14.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$131.08
|
| Rate for Payer: Networks By Design Commercial |
$113.60
|
| Rate for Payer: Prime Health Services Commercial |
$148.55
|
| Rate for Payer: Prime Health Services Medicare |
$10.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.86
|
| Rate for Payer: Riverside University Health MISP |
$10.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO |
$7.82
|
| Rate for Payer: United Healthcare HMO Rider |
$7.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 ACTIVATED PROTEIN C RESISTANCE
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$135.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.91
|
| Rate for Payer: BCBS Transplant Transplant |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Caremore Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| 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 |
$22.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.32
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$26.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: IEHP medi-cal |
$25.28
|
| Rate for Payer: IEHP Medicare Advantage |
$15.32
|
| Rate for Payer: Innovage PACE Commercial |
$22.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: Riverside University Health MISP |
$16.85
|
| 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 |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM ACYCLOVIR
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.22
|
| Rate for Payer: BCBS Transplant Transplant |
$98.40
|
| Rate for Payer: Blue Shield of California Commercial |
$101.35
|
| Rate for Payer: Blue Shield of California EPN |
$79.70
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Central Health Plan Commercial |
$131.20
|
| Rate for Payer: Cigna of CA HMO |
$104.96
|
| Rate for Payer: Cigna of CA PPO |
$121.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: IEHP medi-cal |
$30.76
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Innovage PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.40
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM ACYCLOVIR
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Central Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.60
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
OP
|
$41.20
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: AlphaCare 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 |
$148.99
|
| Rate for Payer: BCBS Transplant Transplant |
$24.72
|
| Rate for Payer: Blue Shield of California Commercial |
$25.46
|
| Rate for Payer: Blue Shield of California EPN |
$20.02
|
| Rate for Payer: Caremore Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Central Health Plan Commercial |
$32.96
|
| Rate for Payer: Cigna of CA HMO |
$26.37
|
| Rate for Payer: Cigna of CA PPO |
$30.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: IEHP medi-cal |
$27.84
|
| Rate for Payer: IEHP Medicare Advantage |
$16.87
|
| Rate for Payer: Innovage PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.24
|
| 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 |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.72
|
| Rate for Payer: Riverside University Health MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.72
|
| 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: 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 ACYLCARNITINE PROFILE(PKU CARD
|
Facility
IP
|
$41.20
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Central Health Plan Commercial |
$32.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.48
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
|
|
HC SOM ACYLGLYCINE
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.15
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$131.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM ACYLGLYCINE
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.16
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Caremore Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: IEHP medi-cal |
$23.30
|
| Rate for Payer: IEHP Medicare Advantage |
$14.12
|
| Rate for Payer: Innovage PACE Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: Riverside University Health MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
OP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.27
|
| Rate for Payer: BCBS Transplant Transplant |
$102.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$82.62
|
| Rate for Payer: Caremore Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$127.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: IEHP medi-cal |
$63.64
|
| Rate for Payer: IEHP Medicare Advantage |
$38.57
|
| Rate for Payer: Innovage PACE Commercial |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: Riverside University Health MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.07
|
| Rate for Payer: BCBS Transplant Transplant |
$87.00
|
| Rate for Payer: Blue Shield of California Commercial |
$89.61
|
| Rate for Payer: Blue Shield of California EPN |
$70.47
|
| Rate for Payer: Caremore Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$108.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: IEHP medi-cal |
$13.36
|
| Rate for Payer: IEHP Medicare Advantage |
$8.10
|
| Rate for Payer: Innovage PACE Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: Riverside University Health MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
|
|
HC SOM ADENOVIRUS DNA PCR
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$31.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.43
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ADENOVIRUS DNA PCR
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM ADENOVIRUS DNA PCR NON-BLOOD
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900910713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$31.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.43
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ADENOVIRUS DNA PCR NON-BLOOD
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900910713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM ADENOVIRUS DNA PCR QUANT
|
Facility
OP
|
$374.90
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$337.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.58
|
| Rate for Payer: BCBS Transplant Transplant |
$224.94
|
| Rate for Payer: Blue Shield of California Commercial |
$231.69
|
| Rate for Payer: Blue Shield of California EPN |
$182.20
|
| Rate for Payer: Caremore Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$168.71
|
| Rate for Payer: Cash Price |
$168.71
|
| Rate for Payer: Central Health Plan Commercial |
$299.92
|
| Rate for Payer: Cigna of CA HMO |
$239.94
|
| Rate for Payer: Cigna of CA PPO |
$277.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$318.66
|
| Rate for Payer: Global Benefits Group Commercial |
$224.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$281.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: IEHP medi-cal |
$70.69
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Innovage PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$281.18
|
| Rate for Payer: Networks By Design Commercial |
$243.68
|
| Rate for Payer: Prime Health Services Commercial |
$318.66
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$224.94
|
| Rate for Payer: Riverside University Health MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM ADENOVIRUS DNA PCR QUANT
|
Facility
IP
|
$374.90
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$337.41 |
| Rate for Payer: Cash Price |
$168.71
|
| Rate for Payer: Central Health Plan Commercial |
$299.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.96
|
| Rate for Payer: Galaxy Health WC |
$318.66
|
| Rate for Payer: Global Benefits Group Commercial |
$224.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.98
|
| Rate for Payer: Multiplan Commercial |
$281.18
|
| Rate for Payer: Networks By Design Commercial |
$243.68
|
| Rate for Payer: Prime Health Services Commercial |
$318.66
|
|
|
HC SOM AF CULT GENE TEST CELLS
|
Facility
OP
|
$210.92
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915286
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$12,174.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$979.74
|
| Rate for Payer: BCBS Transplant Transplant |
$126.55
|
| Rate for Payer: Blue Shield of California Commercial |
$130.35
|
| Rate for Payer: Blue Shield of California EPN |
$102.51
|
| Rate for Payer: Caremore Medicare Advantage |
$150.30
|
| Rate for Payer: Cash Price |
$94.91
|
| Rate for Payer: Cash Price |
$94.91
|
| Rate for Payer: Central Health Plan Commercial |
$168.74
|
| Rate for Payer: Cigna of CA HMO |
$134.99
|
| Rate for Payer: Cigna of CA PPO |
$156.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$179.28
|
| Rate for Payer: Global Benefits Group Commercial |
$126.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$158.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: IEHP medi-cal |
$248.00
|
| Rate for Payer: IEHP Medicare Advantage |
$150.30
|
| Rate for Payer: Innovage PACE Commercial |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$158.19
|
| Rate for Payer: Networks By Design Commercial |
$137.10
|
| Rate for Payer: Prime Health Services Commercial |
$179.28
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$126.55
|
| Rate for Payer: Riverside University Health MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,174.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM AF CULT GENE TEST CELLS
|
Facility
IP
|
$210.92
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915286
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$189.83 |
| Rate for Payer: Cash Price |
$94.91
|
| Rate for Payer: Central Health Plan Commercial |
$168.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.37
|
| Rate for Payer: Galaxy Health WC |
$179.28
|
| Rate for Payer: Global Benefits Group Commercial |
$126.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.18
|
| Rate for Payer: Multiplan Commercial |
$158.19
|
| Rate for Payer: Networks By Design Commercial |
$137.10
|
| Rate for Payer: Prime Health Services Commercial |
$179.28
|
|
|
HC SOM AF CULT GENE TEST CRYO
|
Facility
OP
|
$14.46
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$1,058.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.50
|
| Rate for Payer: BCBS Transplant Transplant |
$8.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.94
|
| Rate for Payer: Blue Shield of California EPN |
$7.03
|
| Rate for Payer: Caremore Medicare Advantage |
$13.07
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Central Health Plan Commercial |
$11.57
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$10.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.07
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.43
|
| Rate for Payer: IEHP medi-cal |
$21.57
|
| Rate for Payer: IEHP Medicare Advantage |
$13.07
|
| Rate for Payer: Innovage PACE Commercial |
$19.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$10.84
|
| Rate for Payer: Networks By Design Commercial |
$9.40
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Prime Health Services Medicare |
$13.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: Riverside University Health MISP |
$14.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,058.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
