|
HC SOM HCG HIGH SENSITIVITY
|
Facility
OP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$127.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.84
|
| Rate for Payer: BCBS Transplant Transplant |
$10.06
|
| Rate for Payer: Blue Shield of California Commercial |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.15
|
| Rate for Payer: Caremore Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Central Health Plan Commercial |
$13.42
|
| Rate for Payer: Cigna of CA HMO |
$10.73
|
| Rate for Payer: Cigna of CA PPO |
$12.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$14.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: IEHP medi-cal |
$24.83
|
| Rate for Payer: IEHP Medicare Advantage |
$15.05
|
| Rate for Payer: Innovage PACE Commercial |
$22.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$12.58
|
| Rate for Payer: Networks By Design Commercial |
$10.90
|
| Rate for Payer: Prime Health Services Commercial |
$14.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.06
|
| Rate for Payer: Riverside University Health MISP |
$16.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM HCG HIGH SENSITIVITY
|
Facility
IP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Central Health Plan Commercial |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.71
|
| Rate for Payer: Galaxy Health WC |
$14.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$12.58
|
| Rate for Payer: Networks By Design Commercial |
$10.90
|
| Rate for Payer: Prime Health Services Commercial |
$14.25
|
|
|
HC SOM HCV GENOTYPING
|
Facility
IP
|
$125.55
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Central Health Plan Commercial |
$100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: Galaxy Health WC |
$106.72
|
| Rate for Payer: Global Benefits Group Commercial |
$75.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.11
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
| Rate for Payer: Networks By Design Commercial |
$81.61
|
| Rate for Payer: Prime Health Services Commercial |
$106.72
|
|
|
HC SOM HCV GENOTYPING
|
Facility
OP
|
$125.55
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$2,282.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$257.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,889.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$283.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,871.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.96
|
| Rate for Payer: BCBS Transplant Transplant |
$75.33
|
| Rate for Payer: Blue Shield of California Commercial |
$77.59
|
| Rate for Payer: Blue Shield of California EPN |
$61.02
|
| Rate for Payer: Caremore Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Central Health Plan Commercial |
$100.44
|
| Rate for Payer: Cigna of CA HMO |
$80.35
|
| Rate for Payer: Cigna of CA PPO |
$92.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$257.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.45
|
| Rate for Payer: Galaxy Health WC |
$106.72
|
| Rate for Payer: Global Benefits Group Commercial |
$75.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$422.22
|
| Rate for Payer: IEHP medi-cal |
$424.79
|
| Rate for Payer: IEHP Medicare Advantage |
$257.45
|
| Rate for Payer: Innovage PACE Commercial |
$386.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
| Rate for Payer: Networks By Design Commercial |
$81.61
|
| Rate for Payer: Prime Health Services Commercial |
$106.72
|
| Rate for Payer: Prime Health Services Medicare |
$272.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.33
|
| Rate for Payer: Riverside University Health MISP |
$283.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.54
|
| Rate for Payer: United Healthcare All Other HMO |
$208.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.20
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM HEMO A INV INTERP
|
Facility
IP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$497.74 |
| Rate for Payer: Cash Price |
$248.87
|
| Rate for Payer: Central Health Plan Commercial |
$442.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.22
|
| Rate for Payer: Galaxy Health WC |
$470.09
|
| Rate for Payer: Global Benefits Group Commercial |
$331.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.61
|
| Rate for Payer: Multiplan Commercial |
$414.79
|
| Rate for Payer: Networks By Design Commercial |
$359.48
|
| Rate for Payer: Prime Health Services Commercial |
$470.09
|
|
|
HC SOM HEMO A INV INTERP
|
Facility
OP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$1,327.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.96
|
| Rate for Payer: BCBS Transplant Transplant |
$331.83
|
| Rate for Payer: Blue Shield of California Commercial |
$341.78
|
| Rate for Payer: Blue Shield of California EPN |
$268.78
|
| Rate for Payer: Caremore Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$248.87
|
| Rate for Payer: Cash Price |
$248.87
|
| Rate for Payer: Central Health Plan Commercial |
$442.44
|
| Rate for Payer: Cigna of CA HMO |
$353.95
|
| Rate for Payer: Cigna of CA PPO |
$409.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$470.09
|
| Rate for Payer: Global Benefits Group Commercial |
$331.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$497.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$414.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: IEHP medi-cal |
$305.58
|
| Rate for Payer: IEHP Medicare Advantage |
$185.20
|
| Rate for Payer: Innovage PACE Commercial |
$277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$414.79
|
| Rate for Payer: Networks By Design Commercial |
$359.48
|
| Rate for Payer: Prime Health Services Commercial |
$470.09
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$331.83
|
| Rate for Payer: Riverside University Health MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
OP
|
$95.84
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$477.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$65.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$391.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.92
|
| Rate for Payer: BCBS Transplant Transplant |
$57.50
|
| Rate for Payer: Blue Shield of California Commercial |
$59.23
|
| Rate for Payer: Blue Shield of California EPN |
$46.58
|
| Rate for Payer: Caremore Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Central Health Plan Commercial |
$76.67
|
| Rate for Payer: Cigna of CA HMO |
$61.34
|
| Rate for Payer: Cigna of CA PPO |
$70.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.36
|
| Rate for Payer: Galaxy Health WC |
$81.46
|
| Rate for Payer: Global Benefits Group Commercial |
$57.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.19
|
| Rate for Payer: IEHP medi-cal |
$107.84
|
| Rate for Payer: IEHP Medicare Advantage |
$65.36
|
| Rate for Payer: Innovage PACE Commercial |
$98.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.58
|
| Rate for Payer: Multiplan Commercial |
$71.88
|
| Rate for Payer: Networks By Design Commercial |
$62.30
|
| Rate for Payer: Prime Health Services Commercial |
$81.46
|
| Rate for Payer: Prime Health Services Medicare |
$69.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.50
|
| Rate for Payer: Riverside University Health MISP |
$71.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.94
|
| Rate for Payer: United Healthcare All Other HMO |
$52.94
|
| Rate for Payer: United Healthcare HMO Rider |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
IP
|
$95.84
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$86.26 |
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Central Health Plan Commercial |
$76.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.34
|
| Rate for Payer: Galaxy Health WC |
$81.46
|
| Rate for Payer: Global Benefits Group Commercial |
$57.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.17
|
| Rate for Payer: Multiplan Commercial |
$71.88
|
| Rate for Payer: Networks By Design Commercial |
$62.30
|
| Rate for Payer: Prime Health Services Commercial |
$81.46
|
|
|
HC SOM HEMOGLOBIN QUAL URINE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900912526
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.09
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| 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 |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.71
|
| Rate for Payer: IEHP medi-cal |
$5.74
|
| Rate for Payer: IEHP Medicare Advantage |
$3.48
|
| Rate for Payer: Innovage PACE Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$3.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health MISP |
$3.83
|
| 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 |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SOM HEMOGLOBIN QUAL URINE
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900912526
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$10.00
|
| 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 HEMOSIDERIN, URINE
|
Facility
IP
|
$125.67
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Central Health Plan Commercial |
$100.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.27
|
| Rate for Payer: Galaxy Health WC |
$106.82
|
| Rate for Payer: Global Benefits Group Commercial |
$75.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$94.25
|
| Rate for Payer: Networks By Design Commercial |
$81.69
|
| Rate for Payer: Prime Health Services Commercial |
$106.82
|
|
|
HC SOM HEMOSIDERIN, URINE
|
Facility
OP
|
$125.67
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.12
|
| Rate for Payer: BCBS Transplant Transplant |
$75.40
|
| Rate for Payer: Blue Shield of California Commercial |
$77.66
|
| Rate for Payer: Blue Shield of California EPN |
$61.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Central Health Plan Commercial |
$100.54
|
| Rate for Payer: Cigna of CA HMO |
$80.43
|
| Rate for Payer: Cigna of CA PPO |
$93.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$106.82
|
| Rate for Payer: Global Benefits Group Commercial |
$75.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: IEHP medi-cal |
$7.84
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Innovage PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$94.25
|
| Rate for Payer: Networks By Design Commercial |
$81.69
|
| Rate for Payer: Prime Health Services Commercial |
$106.82
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.40
|
| Rate for Payer: Riverside University Health MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$138.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.30
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: IEHP medi-cal |
$30.31
|
| Rate for Payer: IEHP Medicare Advantage |
$18.37
|
| Rate for Payer: Innovage PACE Commercial |
$27.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$19.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$20.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
IP
|
$79.33
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Central Health Plan Commercial |
$63.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: Galaxy Health WC |
$67.43
|
| Rate for Payer: Global Benefits Group Commercial |
$47.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.87
|
| Rate for Payer: Multiplan Commercial |
$59.50
|
| Rate for Payer: Networks By Design Commercial |
$51.56
|
| Rate for Payer: Prime Health Services Commercial |
$67.43
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
OP
|
$79.33
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$314.39 |
| 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 |
$47.60
|
| Rate for Payer: Blue Shield of California Commercial |
$49.03
|
| Rate for Payer: Blue Shield of California EPN |
$38.55
|
| Rate for Payer: Caremore Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Central Health Plan Commercial |
$63.46
|
| Rate for Payer: Cigna of CA HMO |
$50.77
|
| Rate for Payer: Cigna of CA PPO |
$58.70
|
| 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 |
$67.43
|
| Rate for Payer: Global Benefits Group Commercial |
$47.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$59.50
|
| 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 |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.87
|
| 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 |
$59.50
|
| Rate for Payer: Networks By Design Commercial |
$51.56
|
| Rate for Payer: Prime Health Services Commercial |
$67.43
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$47.60
|
| Rate for Payer: Riverside University Health MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.60
|
| 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 HEPATITIS BE AB
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.29
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Caremore Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.57
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.97
|
| Rate for Payer: IEHP medi-cal |
$19.09
|
| Rate for Payer: IEHP Medicare Advantage |
$11.57
|
| Rate for Payer: Innovage PACE Commercial |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: Riverside University Health MISP |
$12.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.37
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare HMO Rider |
$9.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$142.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.96
|
| Rate for Payer: BCBS Transplant Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$17.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.16
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.14
|
| Rate for Payer: IEHP medi-cal |
$28.31
|
| Rate for Payer: IEHP Medicare Advantage |
$17.16
|
| Rate for Payer: Innovage PACE Commercial |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.99
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$18.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$18.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.90
|
| Rate for Payer: United Healthcare All Other HMO |
$13.90
|
| Rate for Payer: United Healthcare HMO Rider |
$13.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Vantage Medical Group Senior |
$17.16
|
|
|
HC SOM HHEMO 81256
|
Facility
IP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.88 |
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Central Health Plan Commercial |
$56.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.39
|
| Rate for Payer: Galaxy Health WC |
$60.33
|
| Rate for Payer: Global Benefits Group Commercial |
$42.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.24
|
| Rate for Payer: Networks By Design Commercial |
$46.14
|
| Rate for Payer: Prime Health Services Commercial |
$60.33
|
|
|
HC SOM HHEMO 81256
|
Facility
OP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$477.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$65.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$244.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$391.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.92
|
| Rate for Payer: BCBS Transplant Transplant |
$42.59
|
| Rate for Payer: Blue Shield of California Commercial |
$43.87
|
| Rate for Payer: Blue Shield of California EPN |
$34.50
|
| Rate for Payer: Caremore Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Central Health Plan Commercial |
$56.78
|
| Rate for Payer: Cigna of CA HMO |
$45.43
|
| Rate for Payer: Cigna of CA PPO |
$52.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.36
|
| Rate for Payer: Galaxy Health WC |
$60.33
|
| Rate for Payer: Global Benefits Group Commercial |
$42.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.19
|
| Rate for Payer: IEHP medi-cal |
$107.84
|
| Rate for Payer: IEHP Medicare Advantage |
$65.36
|
| Rate for Payer: Innovage PACE Commercial |
$98.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.58
|
| Rate for Payer: Multiplan Commercial |
$53.24
|
| Rate for Payer: Networks By Design Commercial |
$46.14
|
| Rate for Payer: Prime Health Services Commercial |
$60.33
|
| Rate for Payer: Prime Health Services Medicare |
$69.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.59
|
| Rate for Payer: Riverside University Health MISP |
$71.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.94
|
| Rate for Payer: United Healthcare All Other HMO |
$52.94
|
| Rate for Payer: United Healthcare HMO Rider |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$262.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$216.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.02
|
| 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 |
$29.53
|
| 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 |
$44.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.53
|
| 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 |
$48.43
|
| Rate for Payer: IEHP medi-cal |
$48.72
|
| Rate for Payer: IEHP Medicare Advantage |
$29.53
|
| Rate for Payer: Innovage PACE Commercial |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.57
|
| 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 |
$31.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: Riverside University Health MISP |
$32.48
|
| 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 |
$23.92
|
| Rate for Payer: United Healthcare All Other HMO |
$23.92
|
| Rate for Payer: United Healthcare HMO Rider |
$23.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$29.53
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| 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 HISTOPLAS BLASTOMYC PCR1
|
Facility
OP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| 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 |
$88.87
|
| Rate for Payer: Blue Shield of California Commercial |
$91.54
|
| Rate for Payer: Blue Shield of California EPN |
$71.99
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Central Health Plan Commercial |
$118.50
|
| Rate for Payer: Cigna of CA HMO |
$94.80
|
| Rate for Payer: Cigna of CA PPO |
$109.61
|
| 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 |
$125.90
|
| Rate for Payer: Global Benefits Group Commercial |
$88.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$111.09
|
| 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 |
$98.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.62
|
| 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 |
$111.09
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.90
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$88.87
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.87
|
| 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
|
|
