|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California EPN |
$20.90
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$282.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.72
|
| Rate for Payer: BCBS Transplant Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.83
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Caremore Medicare Advantage |
$38.50
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.50
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.14
|
| Rate for Payer: IEHP medi-cal |
$63.52
|
| Rate for Payer: IEHP Medicare Advantage |
$38.50
|
| Rate for Payer: Innovage PACE Commercial |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.59
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$40.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: Riverside University Health MISP |
$42.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.18
|
| Rate for Payer: United Healthcare All Other HMO |
$31.18
|
| Rate for Payer: United Healthcare HMO Rider |
$31.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Vantage Medical Group Senior |
$38.50
|
|
|
HC LAB REF VITAMIN E
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC LAB REF VITAMIN E
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.75
|
| Rate for Payer: BCBS Transplant Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.18
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.26
|
| Rate for Payer: IEHP medi-cal |
$23.40
|
| Rate for Payer: IEHP Medicare Advantage |
$14.18
|
| Rate for Payer: Innovage PACE Commercial |
$21.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$15.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: Riverside University Health MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11.48
|
| Rate for Payer: United Healthcare HMO Rider |
$11.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.18
|
|
|
HC LAB REF VITAMIN K
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC LAB REF VITAMIN K
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.69
|
| Rate for Payer: BCBS Transplant Transplant |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$31.52
|
| Rate for Payer: Blue Shield of California EPN |
$24.79
|
| Rate for Payer: Caremore Medicare Advantage |
$13.72
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.72
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.50
|
| Rate for Payer: IEHP medi-cal |
$22.64
|
| Rate for Payer: IEHP Medicare Advantage |
$13.72
|
| Rate for Payer: Innovage PACE Commercial |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Medicare |
$14.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: Riverside University Health MISP |
$15.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.72
|
|
|
HC LAB REF VZV AB IMMUNITY SCREEN
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC LAB REF VZV AB IMMUNITY SCREEN
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$52.20
|
| Rate for Payer: Blue Shield of California Commercial |
$53.77
|
| Rate for Payer: Blue Shield of California EPN |
$42.28
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| 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 |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| 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 |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| 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 WHITE BEAN IGE
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: BCBS Transplant Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: IEHP medi-cal |
$8.61
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Innovage PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: Riverside University Health MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LAB REF ZINC URINE
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$101.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.08
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.39
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.68
|
| Rate for Payer: IEHP medi-cal |
$18.79
|
| Rate for Payer: IEHP Medicare Advantage |
$11.39
|
| Rate for Payer: Innovage PACE Commercial |
$17.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$12.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC LAB REF ZINC URINE
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC LACER WT BEARING MOLDED KAFO
|
Facility
IP
|
$834.00
|
|
|
Service Code
|
CPT L2540
|
| Hospital Charge Code |
905352540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$750.60 |
| Rate for Payer: Blue Shield of California EPN |
$445.36
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Central Health Plan Commercial |
$667.20
|
| Rate for Payer: Cigna of CA HMO |
$583.80
|
| Rate for Payer: Cigna of CA PPO |
$583.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$750.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: Networks By Design Commercial |
$417.00
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
|
|
HC LACER WT BEARING MOLDED KAFO
|
Facility
OP
|
$834.00
|
|
|
Service Code
|
CPT L2540
|
| Hospital Charge Code |
905352540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$1,755.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,755.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$708.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$458.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$458.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$403.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.73
|
| Rate for Payer: BCBS Transplant Transplant |
$500.40
|
| Rate for Payer: Blue Shield of California Commercial |
$625.50
|
| Rate for Payer: Blue Shield of California EPN |
$453.70
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Central Health Plan Commercial |
$667.20
|
| Rate for Payer: Cigna of CA HMO |
$583.80
|
| Rate for Payer: Cigna of CA PPO |
$583.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$750.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$625.50
|
| Rate for Payer: IEHP medi-cal |
$291.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.94
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: Networks By Design Commercial |
$417.00
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: Riverside University Health MISP |
$333.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$500.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$500.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$417.00
|
| Rate for Payer: United Healthcare HMO Rider |
$417.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$417.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.90
|
| Rate for Payer: Vantage Medical Group Senior |
$708.90
|
|
|
HC LACER WT BEARING NON-MOLDED
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT L2530
|
| Hospital Charge Code |
905352530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$975.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$975.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$413.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$267.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.13
|
| Rate for Payer: BCBS Transplant Transplant |
$291.60
|
| Rate for Payer: Blue Shield of California Commercial |
$364.50
|
| Rate for Payer: Blue Shield of California EPN |
$264.38
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$364.50
|
| Rate for Payer: IEHP medi-cal |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.26
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
| Rate for Payer: Riverside University Health MISP |
$194.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.00
|
| Rate for Payer: United Healthcare All Other HMO |
$243.00
|
| Rate for Payer: United Healthcare HMO Rider |
$243.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.10
|
| Rate for Payer: Vantage Medical Group Senior |
$413.10
|
|
|
HC LACER WT BEARING NON-MOLDED
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT L2530
|
| Hospital Charge Code |
905352530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Blue Shield of California EPN |
$259.52
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Central Health Plan Commercial |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$340.20
|
| Rate for Payer: Cigna of CA PPO |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.40
|
| Rate for Payer: Galaxy Health WC |
$413.10
|
| Rate for Payer: Global Benefits Group Commercial |
$291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: Networks By Design Commercial |
$243.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.10
|
|
|
HC LACTATE (CSF/POC)
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$94.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$77.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.75
|
| Rate for Payer: BCBS Transplant Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.57
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.97
|
| Rate for Payer: IEHP medi-cal |
$19.09
|
| Rate for Payer: IEHP Medicare Advantage |
$11.57
|
| Rate for Payer: Innovage PACE Commercial |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$12.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: Riverside University Health MISP |
$12.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.37
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare HMO Rider |
$9.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC LACTATE (CSF/POC)
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Central Health Plan Commercial |
$222.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$250.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.60
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.41
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.91
|
| Rate for Payer: IEHP medi-cal |
$9.97
|
| Rate for Payer: IEHP Medicare Advantage |
$6.04
|
| Rate for Payer: Innovage PACE Commercial |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$6.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC LACTATE DEHYDROGENASE BODY FL
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.41
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.91
|
| Rate for Payer: IEHP medi-cal |
$9.97
|
| Rate for Payer: IEHP Medicare Advantage |
$6.04
|
| Rate for Payer: Innovage PACE Commercial |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$6.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$6.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC LACTATE DEHYDROGENASE BODY FL
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC LACTOSE TOLERANCE
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$114.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.22
|
| Rate for Payer: BCBS Transplant 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 |
$12.87
|
| 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 |
$19.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| 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 Transplant Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: IEHP medi-cal |
$21.24
|
| Rate for Payer: IEHP Medicare Advantage |
$12.87
|
| Rate for Payer: Innovage PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| 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 |
$13.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: Riverside University Health MISP |
$14.16
|
| 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 |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
