|
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: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$3,432.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: AlphaCare 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 |
$1,858.15
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Caremore Medicare Advantage |
$42.38
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| 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: EPIC Health Plan Commercial |
$57.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.50
|
| Rate for Payer: IEHP medi-cal |
$69.93
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health 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 |
$3,432.60
|
| 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 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: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$3,432.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: AlphaCare 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 |
$1,858.15
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Caremore Medicare Advantage |
$42.38
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| 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: EPIC Health Plan Commercial |
$57.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.50
|
| Rate for Payer: IEHP medi-cal |
$69.93
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health 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 |
$3,432.60
|
| 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: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
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: 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 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 |
$133.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: AlphaCare 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 |
$133.76
|
| 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 |
$15.08
|
| 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 |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: IEHP medi-cal |
$24.88
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$4.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$57.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare 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 |
$57.47
|
| Rate for Payer: BCBS Transplant Transplant |
$5.57
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California EPN |
$4.51
|
| Rate for Payer: Caremore Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cash Price |
$4.18
|
| 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 |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$6.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: IEHP medi-cal |
$10.68
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Innovage PACE Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.19
|
| 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: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$9.70
|
| 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: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$141.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: AlphaCare 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 |
$85.25
|
| Rate for Payer: BCBS Transplant Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.72
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Caremore Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| 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: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: IEHP medi-cal |
$44.73
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: Riverside University Health 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: 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 |
$429.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$91.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: AlphaCare 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 |
$429.11
|
| Rate for Payer: BCBS Transplant Transplant |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$62.83
|
| Rate for Payer: Blue Shield of California EPN |
$49.41
|
| Rate for Payer: Caremore Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| 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: EPIC Health Plan Commercial |
$123.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$91.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$76.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$150.32
|
| Rate for Payer: IEHP medi-cal |
$151.24
|
| Rate for Payer: 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 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 |
$76.24
|
| Rate for Payer: Networks By Design Commercial |
$66.08
|
| Rate for Payer: Prime Health Services Commercial |
$86.41
|
| Rate for Payer: Prime Health Services Medicare |
$97.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$61.00
|
| Rate for Payer: Riverside University Health 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: 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
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
IP
|
$101.66
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Central Health Plan Commercial |
$81.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.66
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$67.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.33
|
| Rate for Payer: Multiplan Commercial |
$76.24
|
| Rate for Payer: Networks By Design Commercial |
$66.08
|
| Rate for Payer: Prime Health Services Commercial |
$86.41
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| 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 |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.59
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| 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 |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.75
|
| 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 |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| 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 |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.13
|
| Rate for Payer: BCBS Transplant Transplant |
$9.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| 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 |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.45
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.45
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
OP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2,710.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$33.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.71
|
| Rate for Payer: BCBS Transplant Transplant |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.64
|
| Rate for Payer: Caremore Medicare Advantage |
$33.47
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$3.38
|
| 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 |
$50.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.47
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$5.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.89
|
| Rate for Payer: IEHP medi-cal |
$55.23
|
| Rate for Payer: IEHP Medicare Advantage |
$33.47
|
| Rate for Payer: Innovage PACE Commercial |
$50.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$35.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: Riverside University Health MISP |
$36.82
|
| 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 |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,710.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
IP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 KPNRP 87798
|
Facility
OP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| 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 |
$94.77
|
| Rate for Payer: Blue Shield of California Commercial |
$97.61
|
| Rate for Payer: Blue Shield of California EPN |
$76.76
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$71.08
|
| Rate for Payer: Cash Price |
$71.08
|
| Rate for Payer: Central Health Plan Commercial |
$126.36
|
| Rate for Payer: Cigna of CA HMO |
$101.09
|
| Rate for Payer: Cigna of CA PPO |
$116.88
|
| 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 |
$134.26
|
| Rate for Payer: Global Benefits Group Commercial |
$94.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$118.46
|
| 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 |
$105.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.59
|
| 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 |
$118.46
|
| Rate for Payer: Networks By Design Commercial |
$102.67
|
| Rate for Payer: Prime Health Services Commercial |
$134.26
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$94.77
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM KPNRP 87798
|
Facility
IP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$142.16 |
| Rate for Payer: Cash Price |
$71.08
|
| Rate for Payer: Central Health Plan Commercial |
$126.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.18
|
| Rate for Payer: Galaxy Health WC |
$134.26
|
| Rate for Payer: Global Benefits Group Commercial |
$94.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.59
|
| Rate for Payer: Multiplan Commercial |
$118.46
|
| Rate for Payer: Networks By Design Commercial |
$102.67
|
| Rate for Payer: Prime Health Services Commercial |
$134.26
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
IP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$72.16
|
| Rate for Payer: Networks By Design Commercial |
$62.54
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
OP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$144.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.77
|
| Rate for Payer: BCBS Transplant Transplant |
$57.73
|
| Rate for Payer: Blue Shield of California Commercial |
$59.46
|
| Rate for Payer: Blue Shield of California EPN |
$46.76
|
| Rate for Payer: Caremore Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$71.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.70
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.31
|
| Rate for Payer: IEHP medi-cal |
$32.50
|
| Rate for Payer: IEHP Medicare Advantage |
$19.70
|
| Rate for Payer: Innovage PACE Commercial |
$29.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$72.16
|
| Rate for Payer: Networks By Design Commercial |
$62.54
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Medicare |
$20.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: Riverside University Health MISP |
$21.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.96
|
| Rate for Payer: United Healthcare All Other HMO |
$15.96
|
| Rate for Payer: United Healthcare HMO Rider |
$15.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Vantage Medical Group Senior |
$19.70
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.13
|
| Rate for Payer: BCBS Transplant Transplant |
$9.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.65
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| 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 |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.45
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.45
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
