|
HC SOM ANTI-NEUTROPHIL CYTOPLASM ANTI
|
Facility
|
IP
|
$23.15
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
900910287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Central Health Plan Commercial |
$18.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.26
|
| Rate for Payer: EPIC Health Plan Senior |
$9.26
|
| Rate for Payer: Galaxy Health WC |
$19.68
|
| Rate for Payer: Global Benefits Group Commercial |
$13.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$19.68
|
|
|
HC SOM ANTINUCLEAR AB,HEP-2 SUB,S
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3.40
|
| Rate for Payer: Galaxy Health WC |
$7.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$6.38
|
| Rate for Payer: Networks By Design Commercial |
$5.53
|
| Rate for Payer: Prime Health Services Commercial |
$7.22
|
|
|
HC SOM ANTINUCLEAR AB,HEP-2 SUB,S
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$112.76 |
| Rate for Payer: Adventist Health Commercial |
$1.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.80
|
| Rate for Payer: Cigna of CA HMO |
$5.44
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.41
|
| Rate for Payer: EPIC Health Plan Senior |
$12.28
|
| Rate for Payer: Galaxy Health WC |
$7.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$6.38
|
| Rate for Payer: Networks By Design Commercial |
$5.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.16
|
| Rate for Payer: Prime Health Services Commercial |
$7.22
|
| Rate for Payer: Prime Health Services Medicare |
$11.83
|
| Rate for Payer: Riverside University Health System MISP |
$12.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.04
|
| Rate for Payer: United Healthcare All Other HMO |
$9.04
|
| Rate for Payer: United Healthcare HMO Rider |
$9.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.16
|
|
|
HC SOM ANTINUCLEAR ANTIBODY(MULTI
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC SOM ANTINUCLEAR ANTIBODY(MULTI
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$112.76 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.76
|
| Rate for Payer: Blue Shield of California Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.41
|
| Rate for Payer: EPIC Health Plan Senior |
$12.28
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.16
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$11.83
|
| Rate for Payer: Riverside University Health System MISP |
$12.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.04
|
| Rate for Payer: United Healthcare All Other HMO |
$9.04
|
| Rate for Payer: United Healthcare HMO Rider |
$9.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.16
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
OP
|
$11.50
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Blue Shield of California Commercial |
$7.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.20
|
| Rate for Payer: Cigna of CA HMO |
$7.36
|
| Rate for Payer: Cigna of CA PPO |
$8.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$9.78
|
| Rate for Payer: Global Benefits Group Commercial |
$6.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$9.78
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
IP
|
$11.50
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.78
|
| Rate for Payer: Global Benefits Group Commercial |
$6.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.78
|
|
|
HC SOM ANTI-STRIATED MUSCLE AB
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911368
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| 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 |
$15.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| 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 |
$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 |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| 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: 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 |
$15.24
|
| 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 |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| 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 |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| 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 ANTI-STRIATED MUSCLE AB
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911368
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| 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 SOM APOLIPOPROTEIN A-1
|
Facility
|
OP
|
$23.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.73
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Central Health Plan Commercial |
$18.70
|
| Rate for Payer: Cigna of CA HMO |
$14.96
|
| Rate for Payer: Cigna of CA PPO |
$17.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$19.87
|
| Rate for Payer: Global Benefits Group Commercial |
$14.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.26
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: Networks By Design Commercial |
$15.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.09
|
| Rate for Payer: Prime Health Services Commercial |
$19.87
|
| Rate for Payer: Prime Health Services Medicare |
$22.36
|
| Rate for Payer: Riverside University Health System MISP |
$23.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.08
|
| Rate for Payer: United Healthcare All Other HMO |
$17.08
|
| Rate for Payer: United Healthcare HMO Rider |
$17.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21.09
|
|
|
HC SOM APOLIPOPROTEIN A-1
|
Facility
|
IP
|
$23.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$21.04 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Central Health Plan Commercial |
$18.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.35
|
| Rate for Payer: EPIC Health Plan Senior |
$9.35
|
| Rate for Payer: Galaxy Health WC |
$19.87
|
| Rate for Payer: Global Benefits Group Commercial |
$14.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: Networks By Design Commercial |
$15.20
|
| Rate for Payer: Prime Health Services Commercial |
$19.87
|
|
|
HC SOM APOLIPOPROTEIN B
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.68
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.26
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.09
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$22.36
|
| Rate for Payer: Riverside University Health System MISP |
$23.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.08
|
| Rate for Payer: United Healthcare All Other HMO |
$17.08
|
| Rate for Payer: United Healthcare HMO Rider |
$17.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21.09
|
|
|
HC SOM APOLIPOPROTEIN B
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$320.02 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$137.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.02
|
| Rate for Payer: Blue Shield of California Commercial |
$141.75
|
| Rate for Payer: Blue Shield of California EPN |
$89.33
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.05
|
| Rate for Payer: EPIC Health Plan Senior |
$150.70
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Prime Health Services Medicare |
$145.22
|
| Rate for Payer: Riverside University Health System MISP |
$150.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM ARSENIC BLOOD
|
Facility
|
OP
|
$29.50
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900910563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$191.88 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.88
|
| Rate for Payer: Blue Shield of California Commercial |
$18.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Central Health Plan Commercial |
$23.60
|
| Rate for Payer: Cigna of CA HMO |
$18.88
|
| Rate for Payer: Cigna of CA PPO |
$21.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.30
|
| Rate for Payer: EPIC Health Plan Senior |
$20.87
|
| Rate for Payer: Galaxy Health WC |
$25.07
|
| Rate for Payer: Global Benefits Group Commercial |
$17.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: Networks By Design Commercial |
$19.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$25.07
|
| Rate for Payer: Prime Health Services Medicare |
$20.11
|
| Rate for Payer: Riverside University Health System MISP |
$20.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO |
$15.36
|
| Rate for Payer: United Healthcare HMO Rider |
$15.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC BLOOD
|
Facility
|
IP
|
$29.50
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900910563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$26.55 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Central Health Plan Commercial |
$23.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.80
|
| Rate for Payer: Galaxy Health WC |
$25.07
|
| Rate for Payer: Global Benefits Group Commercial |
$17.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: Networks By Design Commercial |
$19.18
|
| Rate for Payer: Prime Health Services Commercial |
$25.07
|
|
|
HC SOM ARSENIC SPECIATION, RAND, U
|
Facility
|
OP
|
$93.89
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$191.88 |
| Rate for Payer: Adventist Health Commercial |
$18.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.88
|
| Rate for Payer: Blue Shield of California Commercial |
$59.15
|
| Rate for Payer: Blue Shield of California EPN |
$37.27
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Central Health Plan Commercial |
$75.11
|
| Rate for Payer: Cigna of CA HMO |
$60.09
|
| Rate for Payer: Cigna of CA PPO |
$69.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.30
|
| Rate for Payer: EPIC Health Plan Senior |
$20.87
|
| Rate for Payer: Galaxy Health WC |
$79.81
|
| Rate for Payer: Global Benefits Group Commercial |
$56.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$70.42
|
| Rate for Payer: Networks By Design Commercial |
$61.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$79.81
|
| Rate for Payer: Prime Health Services Medicare |
$20.11
|
| Rate for Payer: Riverside University Health System MISP |
$20.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO |
$15.36
|
| Rate for Payer: United Healthcare HMO Rider |
$15.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC SPECIATION, RAND, U
|
Facility
|
IP
|
$93.89
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Adventist Health Commercial |
$18.78
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Central Health Plan Commercial |
$75.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.56
|
| Rate for Payer: EPIC Health Plan Senior |
$37.56
|
| Rate for Payer: Galaxy Health WC |
$79.81
|
| Rate for Payer: Global Benefits Group Commercial |
$56.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$70.42
|
| Rate for Payer: Networks By Design Commercial |
$61.03
|
| Rate for Payer: Prime Health Services Commercial |
$79.81
|
|
|
HC SOM ARSENIC URINE QUANT
|
Facility
|
OP
|
$34.56
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900911289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$191.88 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21.77
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Central Health Plan Commercial |
$27.65
|
| Rate for Payer: Cigna of CA HMO |
$22.12
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.30
|
| Rate for Payer: EPIC Health Plan Senior |
$20.87
|
| Rate for Payer: Galaxy Health WC |
$29.38
|
| Rate for Payer: Global Benefits Group Commercial |
$20.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: Networks By Design Commercial |
$22.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Medicare |
$20.11
|
| Rate for Payer: Riverside University Health System MISP |
$20.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO |
$15.36
|
| Rate for Payer: United Healthcare HMO Rider |
$15.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM ARSENIC URINE QUANT
|
Facility
|
IP
|
$34.56
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900911289
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$6.91
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Central Health Plan Commercial |
$27.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$29.38
|
| Rate for Payer: Global Benefits Group Commercial |
$20.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.91
|
| Rate for Payer: Multiplan Commercial |
$25.92
|
| Rate for Payer: Networks By Design Commercial |
$22.46
|
| Rate for Payer: Prime Health Services Commercial |
$29.38
|
|
|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
OP
|
$138.77
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$124.89 |
| Rate for Payer: Adventist Health Commercial |
$27.75
|
| 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 |
$87.43
|
| Rate for Payer: Blue Shield of California EPN |
$55.09
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Central Health Plan Commercial |
$111.02
|
| Rate for Payer: Cigna of CA HMO |
$88.81
|
| Rate for Payer: Cigna of CA PPO |
$102.69
|
| 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 |
$97.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.37
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$117.95
|
| Rate for Payer: Global Benefits Group Commercial |
$83.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.89
|
| 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 |
$88.12
|
| 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 |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$104.08
|
| Rate for Payer: Networks By Design Commercial |
$90.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$117.95
|
| 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 |
$83.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.26
|
| 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
|
|
|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
IP
|
$138.77
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$124.89 |
| Rate for Payer: Adventist Health Commercial |
$27.75
|
| Rate for Payer: Cash Price |
$138.77
|
| Rate for Payer: Central Health Plan Commercial |
$111.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.51
|
| Rate for Payer: EPIC Health Plan Senior |
$55.51
|
| Rate for Payer: Galaxy Health WC |
$117.95
|
| Rate for Payer: Global Benefits Group Commercial |
$83.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$104.08
|
| Rate for Payer: Networks By Design Commercial |
$90.20
|
| Rate for Payer: Prime Health Services Commercial |
$117.95
|
|
|
HC SOM ASPERGILLUS AG BAL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900915471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ASPERGILLUS AG BAL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900915471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$91.92 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.92
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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 |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| 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: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| 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 |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
