|
HC LAB REF NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| 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 |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$29.05
|
| Rate for Payer: Blue Shield of California EPN |
$22.84
|
| Rate for Payer: Caremore Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Media |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$35.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: InnovAge PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC LAB REF PARAINFLUENZA AB TYPE 1
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911773
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$19.80
|
| Rate for Payer: Blue Shield of California Commercial |
$20.39
|
| Rate for Payer: Blue Shield of California EPN |
$16.04
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF PARAINFLUENZA AB TYPE 1
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911773
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
HC LAB REF PARAINFLUENZA AB TYPE 2
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
HC LAB REF PARAINFLUENZA AB TYPE 2
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$19.80
|
| Rate for Payer: Blue Shield of California Commercial |
$20.39
|
| Rate for Payer: Blue Shield of California EPN |
$16.04
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF PARAINFLUENZA AB TYPE 3
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912839
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$19.80
|
| Rate for Payer: Blue Shield of California Commercial |
$20.39
|
| Rate for Payer: Blue Shield of California EPN |
$16.04
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF PARAINFLUENZA AB TYPE 3
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912839
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
HC LAB REF PENTOBARBITAL
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900911216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC LAB REF PENTOBARBITAL
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900911216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.50
|
| Rate for Payer: Blue Distinction Transplant |
$108.60
|
| Rate for Payer: Blue Shield of California Commercial |
$111.86
|
| Rate for Payer: Blue Shield of California EPN |
$87.97
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Media |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$135.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Riverside University Health System MISP |
$72.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.50
|
| Rate for Payer: United Healthcare All Other HMO |
$90.50
|
| Rate for Payer: United Healthcare HMO Rider |
$90.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGA
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.38
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGA
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGG
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGG
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.38
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGM
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911383
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.38
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Media |
$16.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911383
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC LAB REF PROSTAGLANINS PGE2
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900910778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.83 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$41.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.46
|
| Rate for Payer: Blue Distinction Transplant |
$241.80
|
| Rate for Payer: Blue Shield of California Commercial |
$249.05
|
| Rate for Payer: Blue Shield of California EPN |
$195.86
|
| Rate for Payer: Caremore Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Cigna of CA HMO |
$257.92
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: Dignity Health Media |
$41.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.77
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$302.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.77
|
| Rate for Payer: InnovAge PACE Commercial |
$62.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.97
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Medicare |
$44.28
|
| Rate for Payer: Riverside University Health System MISP |
$45.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.83
|
| Rate for Payer: United Healthcare All Other HMO |
$33.83
|
| Rate for Payer: United Healthcare HMO Rider |
$33.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.77
|
|
|
HC LAB REF PROSTAGLANINS PGE2
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900910778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC LAB REF PROTEIN ELECT BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC LAB REF PROTEIN ELECT BODY FLUID
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$155.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.03
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.74
|
| Rate for Payer: Dignity Health Media |
$17.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: InnovAge PACE Commercial |
$26.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC LAB REF PROTEIN TOTAL (SO)
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$32.50 |
| 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 |
$26.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.50
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| 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 |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| 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 |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| 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 |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| 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 |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| 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 LAB REF PROTEIN TOTAL (SO)
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC LAB REF PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.34
|
| Rate for Payer: Blue Distinction Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$43.88
|
| Rate for Payer: Blue Shield of California EPN |
$34.51
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Media |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Riverside University Health System MISP |
$28.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC LAB REF PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC LAB REF QUINIDINE
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
900910456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC LAB REF QUINIDINE
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
900910456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$129.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.52
|
| Rate for Payer: Blue Distinction Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.56
|
| Rate for Payer: Caremore Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Media |
$14.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: InnovAge PACE Commercial |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Prime Health Services Medicare |
$15.48
|
| Rate for Payer: Riverside University Health System MISP |
$16.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
