|
HC SOM INFLIXIMAB, QUANT
|
Facility
|
IP
|
$155.31
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
900915310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$139.78 |
| Rate for Payer: Adventist Health Commercial |
$31.06
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Central Health Plan Commercial |
$124.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.12
|
| Rate for Payer: EPIC Health Plan Senior |
$62.12
|
| Rate for Payer: Galaxy Health WC |
$132.01
|
| Rate for Payer: Global Benefits Group Commercial |
$93.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Networks By Design Commercial |
$100.95
|
| Rate for Payer: Prime Health Services Commercial |
$132.01
|
|
|
HC SOM INFLIXIMAB, QUANT
|
Facility
|
OP
|
$155.31
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
900915310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$139.78 |
| Rate for Payer: Adventist Health Commercial |
$31.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care 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 |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$94.27
|
| Rate for Payer: Blue Shield of California EPN |
$61.66
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Central Health Plan Commercial |
$124.25
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$114.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Senior |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$132.01
|
| Rate for Payer: Global Benefits Group Commercial |
$93.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: InnovAge PACE Commercial |
$57.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| 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 |
$116.48
|
| Rate for Payer: Networks By Design Commercial |
$100.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: Prime Health Services Commercial |
$132.01
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.19
|
| 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: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM INFLUENZA A AB TITER (CF)
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
|
|
HC SOM INFLUENZA A AB TITER (CF)
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: Cigna of CA HMO |
$9.44
|
| Rate for Payer: Cigna of CA PPO |
$10.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: InnovAge PACE Commercial |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
| Rate for Payer: Prime Health Services Medicare |
$14.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOM INFLUENZA B AB TITER (CF)
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: Cigna of CA HMO |
$4.80
|
| Rate for Payer: Cigna of CA PPO |
$5.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: InnovAge PACE Commercial |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.55
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Medicare |
$14.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOM INFLUENZA B AB TITER (CF)
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
|
|
HC SOM INHIBIN B
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM INHIBIN B
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
OP
|
$32.21
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$132.24 |
| Rate for Payer: Adventist Health Commercial |
$6.44
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.84
|
| Rate for Payer: Blue Shield of California Commercial |
$19.55
|
| Rate for Payer: Blue Shield of California EPN |
$12.79
|
| Rate for Payer: Cash Price |
$32.21
|
| Rate for Payer: Cash Price |
$32.21
|
| Rate for Payer: Central Health Plan Commercial |
$25.77
|
| Rate for Payer: Cigna of CA HMO |
$20.61
|
| Rate for Payer: Cigna of CA PPO |
$23.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.90
|
| Rate for Payer: EPIC Health Plan Senior |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$27.38
|
| Rate for Payer: Global Benefits Group Commercial |
$19.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.41
|
| Rate for Payer: InnovAge PACE Commercial |
$32.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.69
|
| Rate for Payer: Multiplan Commercial |
$24.16
|
| Rate for Payer: Networks By Design Commercial |
$20.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.41
|
| Rate for Payer: Prime Health Services Commercial |
$27.38
|
| Rate for Payer: Prime Health Services Medicare |
$22.69
|
| Rate for Payer: Riverside University Health System MISP |
$23.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO |
$17.34
|
| Rate for Payer: United Healthcare HMO Rider |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.41
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
IP
|
$32.21
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: Adventist Health Commercial |
$6.44
|
| Rate for Payer: Cash Price |
$32.21
|
| Rate for Payer: Central Health Plan Commercial |
$25.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.88
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$27.38
|
| Rate for Payer: Global Benefits Group Commercial |
$19.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$24.16
|
| Rate for Payer: Networks By Design Commercial |
$20.94
|
| Rate for Payer: Prime Health Services Commercial |
$27.38
|
|
|
HC SOM INSULIN-LIKE GROWTH FACTOR I
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
900911132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM INSULIN-LIKE GROWTH FACTOR I
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
900911132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$123.72 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.11
|
| Rate for Payer: Blue Shield of California Commercial |
$37.94
|
| Rate for Payer: Blue Shield of California EPN |
$24.81
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.70
|
| Rate for Payer: EPIC Health Plan Senior |
$21.26
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.26
|
| Rate for Payer: InnovAge PACE Commercial |
$31.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.49
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.26
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| Rate for Payer: Prime Health Services Medicare |
$22.54
|
| Rate for Payer: Riverside University Health System MISP |
$23.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.22
|
| Rate for Payer: United Healthcare All Other HMO |
$17.22
|
| Rate for Payer: United Healthcare HMO Rider |
$17.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.26
|
|
|
HC SOM INTERPHASES 100-300
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900915276
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,904.23 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.47
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Senior |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: InnovAge PACE Commercial |
$76.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM INTERPHASES 100-300
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900915276
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM INTERPHASES 25-99
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915275
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM INTERPHASES 25-99
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915275
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,523.38 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,523.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.21
|
| Rate for Payer: EPIC Health Plan Senior |
$42.38
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: InnovAge PACE Commercial |
$63.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.79
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Riverside University Health System MISP |
$46.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.33
|
| Rate for Payer: United Healthcare All Other HMO |
$34.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC SOM INTERPHASES LT 25
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,523.38 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,523.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.21
|
| Rate for Payer: EPIC Health Plan Senior |
$42.38
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: InnovAge PACE Commercial |
$63.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.79
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Riverside University Health System MISP |
$46.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.33
|
| Rate for Payer: United Healthcare All Other HMO |
$34.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC SOM INTERPHASES LT 25
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM INTRINSIC FACTOR BLOCKING AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.26
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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 |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| 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: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: InnovAge PACE Commercial |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.08
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Riverside University Health System MISP |
$16.59
|
| 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 |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM INTRINSIC FACTOR BLOCKING AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| 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 IRON LIVER TISSUE
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
HC SOM IRON LIVER TISSUE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$47.12 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$5.94
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.18
|
| Rate for Payer: Blue Shield of California Commercial |
$24.28
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: InnovAge PACE Commercial |
$40.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.11
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$351.80 |
| Rate for Payer: Adventist Health Commercial |
$20.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$91.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$351.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.40
|
| Rate for Payer: Blue Shield of California Commercial |
$61.71
|
| Rate for Payer: Blue Shield of California EPN |
$40.36
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Central Health Plan Commercial |
$81.33
|
| Rate for Payer: Cigna of CA HMO |
$65.06
|
| Rate for Payer: Cigna of CA PPO |
$75.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.74
|
| Rate for Payer: EPIC Health Plan Senior |
$91.66
|
| Rate for Payer: Galaxy Health WC |
$86.41
|
| Rate for Payer: Global Benefits Group Commercial |
$61.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$150.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.66
|
| Rate for Payer: InnovAge PACE Commercial |
$137.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$76.25
|
| Rate for Payer: Networks By Design Commercial |
$66.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$91.66
|
| Rate for Payer: Prime Health Services Commercial |
$86.41
|
| Rate for Payer: Prime Health Services Medicare |
$97.16
|
| Rate for Payer: Riverside University Health System MISP |
$100.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.24
|
| Rate for Payer: United Healthcare All Other HMO |
$74.24
|
| Rate for Payer: United Healthcare HMO Rider |
$74.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$91.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
