|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
OP
|
$29.04
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$52.16 |
| Rate for Payer: Adventist Health Commercial |
$5.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.16
|
| Rate for Payer: Blue Shield of California Commercial |
$18.30
|
| Rate for Payer: Blue Shield of California EPN |
$11.53
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Central Health Plan Commercial |
$23.23
|
| Rate for Payer: Cigna of CA HMO |
$18.59
|
| Rate for Payer: Cigna of CA PPO |
$21.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$24.68
|
| Rate for Payer: Global Benefits Group Commercial |
$17.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$21.78
|
| Rate for Payer: Networks By Design Commercial |
$18.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$24.68
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
IP
|
$45.75
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$41.17 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Central Health Plan Commercial |
$36.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.30
|
| Rate for Payer: EPIC Health Plan Senior |
$18.30
|
| Rate for Payer: Galaxy Health WC |
$38.89
|
| Rate for Payer: Global Benefits Group Commercial |
$27.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: Networks By Design Commercial |
$29.74
|
| Rate for Payer: Prime Health Services Commercial |
$38.89
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
OP
|
$45.75
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$95.96 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.36
|
| Rate for Payer: Blue Shield of California Commercial |
$28.82
|
| Rate for Payer: Blue Shield of California EPN |
$18.16
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Central Health Plan Commercial |
$36.60
|
| Rate for Payer: Cigna of CA HMO |
$29.28
|
| Rate for Payer: Cigna of CA PPO |
$33.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$38.89
|
| Rate for Payer: Global Benefits Group Commercial |
$27.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: Networks By Design Commercial |
$29.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$38.89
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.88
|
| Rate for Payer: United Healthcare All Other HMO |
$22.88
|
| Rate for Payer: United Healthcare HMO Rider |
$22.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$77.69 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.69
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.19
|
| Rate for Payer: EPIC Health Plan Senior |
$10.79
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$10.40
|
| Rate for Payer: Riverside University Health System MISP |
$10.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.95
|
| Rate for Payer: United Healthcare All Other HMO |
$7.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC SOM ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$45.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$41.17 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Central Health Plan Commercial |
$36.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.30
|
| Rate for Payer: EPIC Health Plan Senior |
$18.30
|
| Rate for Payer: Galaxy Health WC |
$38.89
|
| Rate for Payer: Global Benefits Group Commercial |
$27.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: Networks By Design Commercial |
$29.74
|
| Rate for Payer: Prime Health Services Commercial |
$38.89
|
|
|
HC SOM ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$45.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$136.66 |
| Rate for Payer: Adventist Health Commercial |
$9.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.66
|
| Rate for Payer: Blue Shield of California Commercial |
$28.82
|
| Rate for Payer: Blue Shield of California EPN |
$18.16
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Central Health Plan Commercial |
$36.60
|
| Rate for Payer: Cigna of CA HMO |
$29.28
|
| Rate for Payer: Cigna of CA PPO |
$33.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$38.89
|
| Rate for Payer: Global Benefits Group Commercial |
$27.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: Networks By Design Commercial |
$29.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$38.89
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$16.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.98
|
| Rate for Payer: Global Benefits Group Commercial |
$12.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.86
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.98
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
|
OP
|
$21.15
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.85
|
| Rate for Payer: Blue Shield of California Commercial |
$13.32
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$16.92
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.94
|
| Rate for Payer: EPIC Health Plan Senior |
$10.63
|
| Rate for Payer: Galaxy Health WC |
$17.98
|
| Rate for Payer: Global Benefits Group Commercial |
$12.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$15.86
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.66
|
| Rate for Payer: Prime Health Services Commercial |
$17.98
|
| Rate for Payer: Prime Health Services Medicare |
$10.24
|
| Rate for Payer: Riverside University Health System MISP |
$10.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO |
$7.82
|
| Rate for Payer: United Healthcare HMO Rider |
$7.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
IP
|
$45.50
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Adventist Health Commercial |
$9.10
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Central Health Plan Commercial |
$36.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Senior |
$18.20
|
| Rate for Payer: Galaxy Health WC |
$38.67
|
| Rate for Payer: Global Benefits Group Commercial |
$27.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$34.12
|
| Rate for Payer: Networks By Design Commercial |
$29.57
|
| Rate for Payer: Prime Health Services Commercial |
$38.67
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$45.50
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$154.90 |
| Rate for Payer: Adventist Health Commercial |
$9.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.66
|
| Rate for Payer: Blue Shield of California EPN |
$18.06
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Central Health Plan Commercial |
$36.40
|
| Rate for Payer: Cigna of CA HMO |
$29.12
|
| Rate for Payer: Cigna of CA PPO |
$33.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$38.67
|
| Rate for Payer: Global Benefits Group Commercial |
$27.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$34.12
|
| Rate for Payer: Networks By Design Commercial |
$29.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.67
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
OP
|
$54.62
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$169.82 |
| Rate for Payer: Adventist Health Commercial |
$10.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.82
|
| Rate for Payer: Blue Shield of California Commercial |
$34.41
|
| Rate for Payer: Blue Shield of California EPN |
$21.68
|
| Rate for Payer: Cash Price |
$54.62
|
| Rate for Payer: Cash Price |
$54.62
|
| Rate for Payer: Central Health Plan Commercial |
$43.70
|
| Rate for Payer: Cigna of CA HMO |
$34.96
|
| Rate for Payer: Cigna of CA PPO |
$40.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$46.43
|
| Rate for Payer: Global Benefits Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$40.97
|
| Rate for Payer: Networks By Design Commercial |
$35.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$46.43
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
IP
|
$54.62
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Adventist Health Commercial |
$10.92
|
| Rate for Payer: Cash Price |
$54.62
|
| Rate for Payer: Central Health Plan Commercial |
$43.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$21.85
|
| Rate for Payer: Galaxy Health WC |
$46.43
|
| Rate for Payer: Global Benefits Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$40.97
|
| Rate for Payer: Networks By Design Commercial |
$35.50
|
| Rate for Payer: Prime Health Services Commercial |
$46.43
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$142.92 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.92
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.53
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.12
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Riverside University Health System MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Blue Shield of California Commercial |
$107.10
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM ADALIMUMAB, QUANT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
900915311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC SOM ADAMTS13 ACTIVITY ASSAY
|
Facility
|
OP
|
$136.58
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900915523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$231.37 |
| Rate for Payer: Adventist Health Commercial |
$27.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.37
|
| Rate for Payer: Blue Shield of California Commercial |
$86.05
|
| Rate for Payer: Blue Shield of California EPN |
$54.22
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Central Health Plan Commercial |
$109.26
|
| Rate for Payer: Cigna of CA HMO |
$87.41
|
| Rate for Payer: Cigna of CA PPO |
$101.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.92
|
| Rate for Payer: EPIC Health Plan Senior |
$33.95
|
| Rate for Payer: Galaxy Health WC |
$116.09
|
| Rate for Payer: Global Benefits Group Commercial |
$81.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.35
|
| Rate for Payer: Multiplan Commercial |
$102.44
|
| Rate for Payer: Networks By Design Commercial |
$88.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$116.09
|
| Rate for Payer: Prime Health Services Medicare |
$32.71
|
| Rate for Payer: Riverside University Health System MISP |
$33.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM ADAMTS13 ACTIVITY ASSAY
|
Facility
|
IP
|
$136.58
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900915523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$27.32
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Central Health Plan Commercial |
$109.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.63
|
| Rate for Payer: EPIC Health Plan Senior |
$54.63
|
| Rate for Payer: Galaxy Health WC |
$116.09
|
| Rate for Payer: Global Benefits Group Commercial |
$81.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.32
|
| Rate for Payer: Multiplan Commercial |
$102.44
|
| Rate for Payer: Networks By Design Commercial |
$88.78
|
| Rate for Payer: Prime Health Services Commercial |
$116.09
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
|
|
HC SOM ADENOSINE DEAMINASE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900911409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$91.35
|
| Rate for Payer: Blue Shield of California EPN |
$57.56
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.37
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
