|
HC SOM BCR/ABL P210 QN MON
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
900914648
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$408.47 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.47
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.53
|
| Rate for Payer: EPIC Health Plan Senior |
$180.36
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$229.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$219.71
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.96
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$173.80
|
| Rate for Payer: Riverside University Health System MISP |
$180.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.80
|
| Rate for Payer: United Healthcare All Other HMO |
$132.80
|
| Rate for Payer: United Healthcare HMO Rider |
$132.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.36
|
| Rate for Payer: Vantage Medical Group Senior |
$163.96
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
IP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$33.26 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Central Health Plan Commercial |
$29.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.78
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$31.42
|
| Rate for Payer: Global Benefits Group Commercial |
$22.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.39
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
| Rate for Payer: Networks By Design Commercial |
$24.02
|
| Rate for Payer: Prime Health Services Commercial |
$31.42
|
|
|
HC SOM BENZODIAZEPINE CONFIRM, U
|
Facility
|
OP
|
$36.96
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900912915
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$179.42 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.42
|
| Rate for Payer: Blue Shield of California Commercial |
$23.28
|
| Rate for Payer: Blue Shield of California EPN |
$14.67
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Central Health Plan Commercial |
$29.57
|
| Rate for Payer: Cigna of CA HMO |
$23.65
|
| Rate for Payer: Cigna of CA PPO |
$27.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.78
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$31.42
|
| Rate for Payer: Global Benefits Group Commercial |
$22.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.87
|
| Rate for Payer: Multiplan Commercial |
$27.72
|
| Rate for Payer: Networks By Design Commercial |
$24.02
|
| Rate for Payer: Prime Health Services Commercial |
$31.42
|
| Rate for Payer: Riverside University Health System MISP |
$14.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.48
|
| Rate for Payer: United Healthcare All Other HMO |
$18.48
|
| Rate for Payer: United Healthcare HMO Rider |
$18.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.42
|
| Rate for Payer: Vantage Medical Group Senior |
$31.42
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
OP
|
$55.83
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$163.69 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.69
|
| Rate for Payer: Blue Shield of California Commercial |
$35.17
|
| Rate for Payer: Blue Shield of California EPN |
$22.16
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Central Health Plan Commercial |
$44.66
|
| Rate for Payer: Cigna of CA HMO |
$35.73
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: EPIC Health Plan Senior |
$17.80
|
| Rate for Payer: Galaxy Health WC |
$47.46
|
| Rate for Payer: Global Benefits Group Commercial |
$33.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$41.87
|
| Rate for Payer: Networks By Design Commercial |
$36.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$47.46
|
| Rate for Payer: Prime Health Services Medicare |
$17.15
|
| Rate for Payer: Riverside University Health System MISP |
$17.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.10
|
| Rate for Payer: United Healthcare All Other HMO |
$13.10
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 MICROGLOBULIN CSF
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911369
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Central Health Plan Commercial |
$44.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.33
|
| Rate for Payer: EPIC Health Plan Senior |
$22.33
|
| Rate for Payer: Galaxy Health WC |
$47.46
|
| Rate for Payer: Global Benefits Group Commercial |
$33.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$41.87
|
| Rate for Payer: Networks By Design Commercial |
$36.29
|
| Rate for Payer: Prime Health Services Commercial |
$47.46
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
|
|
HC SOM BETA-2 MICROGLOBULINS
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900914717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$163.69 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.28
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: EPIC Health Plan Senior |
$17.80
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
| Rate for Payer: Prime Health Services Medicare |
$17.15
|
| Rate for Payer: Riverside University Health System MISP |
$17.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.10
|
| Rate for Payer: United Healthcare All Other HMO |
$13.10
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$163.69 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.69
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.70
|
| Rate for Payer: EPIC Health Plan Senior |
$17.80
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$17.15
|
| Rate for Payer: Riverside University Health System MISP |
$17.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.10
|
| Rate for Payer: United Healthcare All Other HMO |
$13.10
|
| Rate for Payer: United Healthcare HMO Rider |
$13.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC SOM BETA 2 MICROGLOBULIN URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900911370
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
IP
|
$85.98
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.38 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Central Health Plan Commercial |
$68.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.39
|
| Rate for Payer: EPIC Health Plan Senior |
$34.39
|
| Rate for Payer: Galaxy Health WC |
$73.08
|
| Rate for Payer: Global Benefits Group Commercial |
$51.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.48
|
| Rate for Payer: Networks By Design Commercial |
$55.89
|
| Rate for Payer: Prime Health Services Commercial |
$73.08
|
|
|
HC SOM BETA 2 TRANSFERRIN (TAU)
|
Facility
|
OP
|
$85.98
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900911443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$215.42 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.74
|
| Rate for Payer: Blue Shield of California Commercial |
$54.17
|
| Rate for Payer: Blue Shield of California EPN |
$34.13
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Central Health Plan Commercial |
$68.78
|
| Rate for Payer: Cigna of CA HMO |
$55.03
|
| Rate for Payer: Cigna of CA PPO |
$63.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.43
|
| Rate for Payer: EPIC Health Plan Senior |
$32.28
|
| Rate for Payer: Galaxy Health WC |
$73.08
|
| Rate for Payer: Global Benefits Group Commercial |
$51.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$64.48
|
| Rate for Payer: Networks By Design Commercial |
$55.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.35
|
| Rate for Payer: Prime Health Services Commercial |
$73.08
|
| Rate for Payer: Prime Health Services Medicare |
$31.11
|
| Rate for Payer: Riverside University Health System MISP |
$32.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.78
|
| Rate for Payer: United Healthcare All Other HMO |
$23.78
|
| Rate for Payer: United Healthcare HMO Rider |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
IP
|
$119.58
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$107.62 |
| Rate for Payer: Adventist Health Commercial |
$23.92
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Central Health Plan Commercial |
$95.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.83
|
| Rate for Payer: EPIC Health Plan Senior |
$47.83
|
| Rate for Payer: Galaxy Health WC |
$101.64
|
| Rate for Payer: Global Benefits Group Commercial |
$71.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$89.69
|
| Rate for Payer: Networks By Design Commercial |
$77.73
|
| Rate for Payer: Prime Health Services Commercial |
$101.64
|
|
|
HC SOM BETA GALACTOSIDASE
|
Facility
|
OP
|
$119.58
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900912511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$23.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$75.34
|
| Rate for Payer: Blue Shield of California EPN |
$47.47
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Cash Price |
$119.58
|
| Rate for Payer: Central Health Plan Commercial |
$95.66
|
| Rate for Payer: Cigna of CA HMO |
$76.53
|
| Rate for Payer: Cigna of CA PPO |
$88.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$101.64
|
| Rate for Payer: Global Benefits Group Commercial |
$71.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$89.69
|
| Rate for Payer: Networks By Design Commercial |
$77.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$101.64
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGA
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$257.18 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$184.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.45
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGA
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGG
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.42 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.41
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGG
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900910565
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$257.18 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$184.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.18
|
| Rate for Payer: Blue Shield of California Commercial |
$22.69
|
| Rate for Payer: Blue Shield of California EPN |
$14.30
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.82
|
| Rate for Payer: Cigna of CA HMO |
$23.05
|
| Rate for Payer: Cigna of CA PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.45
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$257.18 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$184.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.18
|
| Rate for Payer: Blue Shield of California Commercial |
$22.69
|
| Rate for Payer: Blue Shield of California EPN |
$14.30
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.82
|
| Rate for Payer: Cigna of CA HMO |
$23.05
|
| Rate for Payer: Cigna of CA PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.45
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.42 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Central Health Plan Commercial |
$28.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.41
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.02
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
|
|
HC SOM BETA HCG CSF
|
Facility
|
OP
|
$43.10
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$145.71 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.71
|
| Rate for Payer: Blue Shield of California Commercial |
$27.15
|
| Rate for Payer: Blue Shield of California EPN |
$17.11
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Central Health Plan Commercial |
$34.48
|
| Rate for Payer: Cigna of CA HMO |
$27.58
|
| Rate for Payer: Cigna of CA PPO |
$31.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Riverside University Health System MISP |
$16.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM BETA HCG CSF
|
Facility
|
IP
|
$43.10
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$38.79 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Central Health Plan Commercial |
$34.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Senior |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.18
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.37
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.17
|
| Rate for Payer: Riverside University Health System MISP |
$5.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.92
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.25
|
| Rate for Payer: EPIC Health Plan Senior |
$18.83
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.12
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$18.15
|
| Rate for Payer: Riverside University Health System MISP |
$18.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.87
|
| Rate for Payer: United Healthcare All Other HMO |
$13.87
|
| Rate for Payer: United Healthcare HMO Rider |
$13.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Vantage Medical Group Senior |
$17.12
|
|
