|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.62
|
| Rate for Payer: Blue Distinction Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Caremore Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.28
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Central Health Plan Commercial |
$267.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.60
|
| Rate for Payer: Galaxy Health WC |
$283.90
|
| Rate for Payer: Global Benefits Group Commercial |
$200.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.80
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
| Rate for Payer: Networks By Design Commercial |
$217.10
|
| Rate for Payer: Prime Health Services Commercial |
$283.90
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: Blue Distinction Transplant |
$200.40
|
| Rate for Payer: Blue Shield of California Commercial |
$206.41
|
| Rate for Payer: Blue Shield of California EPN |
$162.32
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Central Health Plan Commercial |
$267.20
|
| Rate for Payer: Cigna of CA HMO |
$213.76
|
| Rate for Payer: Cigna of CA PPO |
$247.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Media |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$283.90
|
| Rate for Payer: Global Benefits Group Commercial |
$200.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$250.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: InnovAge PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
| Rate for Payer: Networks By Design Commercial |
$217.10
|
| Rate for Payer: Prime Health Services Commercial |
$283.90
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$111.06 |
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Central Health Plan Commercial |
$98.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.36
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.68
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.21
|
| Rate for Payer: Blue Distinction Transplant |
$74.04
|
| Rate for Payer: Blue Shield of California Commercial |
$76.26
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Caremore Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Central Health Plan Commercial |
$98.72
|
| Rate for Payer: Cigna of CA HMO |
$78.98
|
| Rate for Payer: Cigna of CA PPO |
$91.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Media |
$18.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$92.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PST
|
Facility
|
OP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$136.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.03
|
| Rate for Payer: Blue Distinction Transplant |
$62.01
|
| Rate for Payer: Blue Shield of California Commercial |
$63.87
|
| Rate for Payer: Blue Shield of California EPN |
$50.23
|
| Rate for Payer: Caremore Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Central Health Plan Commercial |
$82.68
|
| Rate for Payer: Cigna of CA HMO |
$66.14
|
| Rate for Payer: Cigna of CA PPO |
$76.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Media |
$15.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$87.85
|
| Rate for Payer: Global Benefits Group Commercial |
$62.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$77.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: InnovAge PACE Commercial |
$22.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
| Rate for Payer: Networks By Design Commercial |
$67.18
|
| Rate for Payer: Prime Health Services Commercial |
$87.85
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PST
|
Facility
|
IP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$93.02 |
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Central Health Plan Commercial |
$82.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.34
|
| Rate for Payer: Galaxy Health WC |
$87.85
|
| Rate for Payer: Global Benefits Group Commercial |
$62.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.67
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
| Rate for Payer: Networks By Design Commercial |
$67.18
|
| Rate for Payer: Prime Health Services Commercial |
$87.85
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: Blue Distinction Transplant |
$9.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.59
|
| Rate for Payer: Caremore Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Central Health Plan Commercial |
$12.50
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$11.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Media |
$14.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: InnovAge PACE Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$11.72
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Riverside University Health System MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Central Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.72
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
|
|
HC SOM PWDNA 81331
|
Facility
|
OP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$505.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$51.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.54
|
| Rate for Payer: Blue Distinction Transplant |
$336.70
|
| Rate for Payer: Blue Shield of California Commercial |
$346.80
|
| Rate for Payer: Blue Shield of California EPN |
$272.73
|
| Rate for Payer: Caremore Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Central Health Plan Commercial |
$448.94
|
| Rate for Payer: Cigna of CA HMO |
$359.15
|
| Rate for Payer: Cigna of CA PPO |
$415.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.60
|
| Rate for Payer: Dignity Health Media |
$51.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.07
|
| Rate for Payer: Galaxy Health WC |
$476.99
|
| Rate for Payer: Global Benefits Group Commercial |
$336.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$505.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$420.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: InnovAge PACE Commercial |
$76.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.43
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
| Rate for Payer: Networks By Design Commercial |
$364.76
|
| Rate for Payer: Prime Health Services Commercial |
$476.99
|
| Rate for Payer: Prime Health Services Medicare |
$54.13
|
| Rate for Payer: Riverside University Health System MISP |
$56.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.36
|
| Rate for Payer: United Healthcare All Other HMO |
$41.36
|
| Rate for Payer: United Healthcare HMO Rider |
$41.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PWDNA 81331
|
Facility
|
IP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$505.05 |
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Central Health Plan Commercial |
$448.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.47
|
| Rate for Payer: Galaxy Health WC |
$476.99
|
| Rate for Payer: Global Benefits Group Commercial |
$336.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$505.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.23
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
| Rate for Payer: Networks By Design Commercial |
$364.76
|
| Rate for Payer: Prime Health Services Commercial |
$476.99
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.70
|
| Rate for Payer: Blue Distinction 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 |
$9.44
|
| 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 |
$14.16
|
| Rate for Payer: Dignity Health Media |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.44
|
| 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) Other |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.65
|
| 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 |
$10.01
|
| Rate for Payer: Riverside University Health System MISP |
$10.38
|
| 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 |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.65
|
| Rate for Payer: United Healthcare HMO Rider |
$7.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| 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: Kaiser Permanente of CA Medi-Cal |
$24.76
|
| 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 Q FEVER AB SCREEN
|
Facility
|
IP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Central Health Plan Commercial |
$32.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.04
|
| Rate for Payer: Galaxy Health WC |
$34.08
|
| Rate for Payer: Global Benefits Group Commercial |
$24.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$30.08
|
| Rate for Payer: Networks By Design Commercial |
$26.06
|
| Rate for Payer: Prime Health Services Commercial |
$34.08
|
|
|
HC SOM Q FEVER AB SCREEN
|
Facility
|
OP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$112.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.01
|
| Rate for Payer: Blue Distinction Transplant |
$24.06
|
| Rate for Payer: Blue Shield of California Commercial |
$24.78
|
| Rate for Payer: Blue Shield of California EPN |
$19.49
|
| Rate for Payer: Caremore Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Central Health Plan Commercial |
$32.08
|
| Rate for Payer: Cigna of CA HMO |
$25.66
|
| Rate for Payer: Cigna of CA PPO |
$29.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Media |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$34.08
|
| Rate for Payer: Global Benefits Group Commercial |
$24.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$30.08
|
| Rate for Payer: Networks By Design Commercial |
$26.06
|
| Rate for Payer: Prime Health Services Commercial |
$34.08
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$112.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.01
|
| Rate for Payer: Blue Distinction Transplant |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Media |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$112.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.01
|
| Rate for Payer: Blue Distinction Transplant |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Media |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
IP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
OP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$112.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.01
|
| Rate for Payer: Blue Distinction Transplant |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$6.42
|
| Rate for Payer: Cigna of CA PPO |
$7.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Media |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
OP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$112.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.01
|
| Rate for Payer: Blue Distinction Transplant |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$6.42
|
| Rate for Payer: Cigna of CA PPO |
$7.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Media |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
IP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$537.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$61.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.96
|
| Rate for Payer: Blue Distinction 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 |
$61.98
|
| 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 |
$92.97
|
| Rate for Payer: Dignity Health Media |
$61.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$61.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.98
|
| 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) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61.98
|
| Rate for Payer: InnovAge PACE Commercial |
$92.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.05
|
| 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 |
$65.70
|
| Rate for Payer: Riverside University Health System MISP |
$68.18
|
| 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 |
$50.20
|
| Rate for Payer: United Healthcare All Other HMO |
$50.20
|
| Rate for Payer: United Healthcare HMO Rider |
$50.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Vantage Medical Group Senior |
$61.98
|
|
