|
HC SOM PKHD1 GENE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,067.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$968.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$899.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$838.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$738.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$887.09
|
| Rate for Payer: Blue Shield of California Commercial |
$960.75
|
| Rate for Payer: Blue Shield of California EPN |
$605.42
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: Cigna of CA HMO |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$1,128.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,296.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,296.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,067.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$968.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$899.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,067.50
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
| Rate for Payer: Riverside University Health System MISP |
$610.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.50
|
| Rate for Payer: United Healthcare All Other HMO |
$762.50
|
| Rate for Payer: United Healthcare HMO Rider |
$762.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,296.25
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$66.18 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.18
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.53
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.92
|
| Rate for Payer: Riverside University Health System MISP |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.53
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
OP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$540.02 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$207.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$388.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.02
|
| Rate for Payer: Blue Shield of California Commercial |
$161.24
|
| Rate for Payer: Blue Shield of California EPN |
$101.61
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Central Health Plan Commercial |
$204.75
|
| Rate for Payer: Cigna of CA HMO |
$163.80
|
| Rate for Payer: Cigna of CA PPO |
$189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$179.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.06
|
| Rate for Payer: EPIC Health Plan Senior |
$228.04
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$339.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$162.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$277.80
|
| Rate for Payer: Multiplan Commercial |
$191.96
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$207.31
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
| Rate for Payer: Prime Health Services Medicare |
$219.75
|
| Rate for Payer: Riverside University Health System MISP |
$228.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.92
|
| Rate for Payer: United Healthcare All Other HMO |
$167.92
|
| Rate for Payer: United Healthcare HMO Rider |
$167.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$207.31
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
IP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Central Health Plan Commercial |
$204.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$179.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.38
|
| Rate for Payer: EPIC Health Plan Senior |
$102.38
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$162.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$191.96
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
|
|
HC SOM PNEUMOCYSTIS PCR
|
Facility
|
OP
|
$94.33
|
|
|
Service Code
|
CPT 87594
|
| Hospital Charge Code |
900915467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$183.03 |
| Rate for Payer: Adventist Health Commercial |
$18.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.92
|
| Rate for Payer: Blue Shield of California Commercial |
$59.43
|
| Rate for Payer: Blue Shield of California EPN |
$37.45
|
| Rate for Payer: Cash Price |
$94.33
|
| Rate for Payer: Cash Price |
$94.33
|
| Rate for Payer: Central Health Plan Commercial |
$75.46
|
| Rate for Payer: Cigna of CA HMO |
$60.37
|
| Rate for Payer: Cigna of CA PPO |
$69.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$80.18
|
| Rate for Payer: Global Benefits Group Commercial |
$56.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$70.75
|
| Rate for Payer: Networks By Design Commercial |
$61.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$80.18
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.16
|
| Rate for Payer: United Healthcare HMO Rider |
$47.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PNEUMOCYSTIS PCR
|
Facility
|
IP
|
$94.33
|
|
|
Service Code
|
CPT 87594
|
| Hospital Charge Code |
900915467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$84.90 |
| Rate for Payer: Adventist Health Commercial |
$18.87
|
| Rate for Payer: Cash Price |
$94.33
|
| Rate for Payer: Central Health Plan Commercial |
$75.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.73
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$80.18
|
| Rate for Payer: Global Benefits Group Commercial |
$56.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.87
|
| Rate for Payer: Multiplan Commercial |
$70.75
|
| Rate for Payer: Networks By Design Commercial |
$61.31
|
| Rate for Payer: Prime Health Services Commercial |
$80.18
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
IP
|
$31.22
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Central Health Plan Commercial |
$24.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.49
|
| Rate for Payer: EPIC Health Plan Senior |
$12.49
|
| Rate for Payer: Galaxy Health WC |
$26.54
|
| Rate for Payer: Global Benefits Group Commercial |
$18.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$23.41
|
| Rate for Payer: Networks By Design Commercial |
$20.29
|
| Rate for Payer: Prime Health Services Commercial |
$26.54
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
OP
|
$31.22
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.45
|
| Rate for Payer: Blue Shield of California Commercial |
$19.67
|
| Rate for Payer: Blue Shield of California EPN |
$12.39
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Central Health Plan Commercial |
$24.98
|
| Rate for Payer: Cigna of CA HMO |
$19.98
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.93
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$26.54
|
| Rate for Payer: Global Benefits Group Commercial |
$18.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$23.41
|
| Rate for Payer: Networks By Design Commercial |
$20.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.44
|
| Rate for Payer: Prime Health Services Commercial |
$26.54
|
| Rate for Payer: Prime Health Services Medicare |
$8.95
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
|
OP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$148.78 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.78
|
| Rate for Payer: Blue Shield of California Commercial |
$13.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.37
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Central Health Plan Commercial |
$16.86
|
| Rate for Payer: Cigna of CA HMO |
$13.49
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$17.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$17.92
|
| Rate for Payer: Prime Health Services Medicare |
$15.59
|
| Rate for Payer: Riverside University Health System MISP |
$16.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
|
IP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Central Health Plan Commercial |
$16.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.43
|
| Rate for Payer: EPIC Health Plan Senior |
$8.43
|
| Rate for Payer: Galaxy Health WC |
$17.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$17.92
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
|
IP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.84
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: Galaxy Health WC |
$10.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: Networks By Design Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$10.28
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
|
OP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.67
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$8.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.93
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$10.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: Networks By Design Commercial |
$7.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.44
|
| Rate for Payer: Prime Health Services Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Medicare |
$8.95
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| 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 |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.37
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| 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 |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| 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 |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
IP
|
$14.22
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Central Health Plan Commercial |
$11.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.69
|
| Rate for Payer: EPIC Health Plan Senior |
$5.69
|
| Rate for Payer: Galaxy Health WC |
$12.09
|
| Rate for Payer: Global Benefits Group Commercial |
$8.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.66
|
| Rate for Payer: Networks By Design Commercial |
$9.24
|
| Rate for Payer: Prime Health Services Commercial |
$12.09
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
OP
|
$14.22
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$148.78 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.65
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Central Health Plan Commercial |
$11.38
|
| Rate for Payer: Cigna of CA HMO |
$9.10
|
| Rate for Payer: Cigna of CA PPO |
$10.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$12.09
|
| Rate for Payer: Global Benefits Group Commercial |
$8.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$10.66
|
| Rate for Payer: Networks By Design Commercial |
$9.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$12.09
|
| Rate for Payer: Prime Health Services Medicare |
$15.59
|
| Rate for Payer: Riverside University Health System MISP |
$16.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
OP
|
$24.78
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Adventist Health Commercial |
$4.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.61
|
| Rate for Payer: Blue Shield of California EPN |
$9.84
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Central Health Plan Commercial |
$19.82
|
| Rate for Payer: Cigna of CA HMO |
$15.86
|
| Rate for Payer: Cigna of CA PPO |
$18.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.93
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$21.06
|
| Rate for Payer: Global Benefits Group Commercial |
$14.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$18.59
|
| Rate for Payer: Networks By Design Commercial |
$16.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.44
|
| Rate for Payer: Prime Health Services Commercial |
$21.06
|
| Rate for Payer: Prime Health Services Medicare |
$8.95
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Adventist Health Commercial |
$4.96
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Central Health Plan Commercial |
$19.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.91
|
| Rate for Payer: EPIC Health Plan Senior |
$9.91
|
| Rate for Payer: Galaxy Health WC |
$21.06
|
| Rate for Payer: Global Benefits Group Commercial |
$14.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$18.59
|
| Rate for Payer: Networks By Design Commercial |
$16.11
|
| Rate for Payer: Prime Health Services Commercial |
$21.06
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$141.37 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.16
|
| Rate for Payer: Blue Shield of California Commercial |
$17.08
|
| Rate for Payer: Blue Shield of California EPN |
$10.76
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.73
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.11
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
OP
|
$358.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$407.52 |
| Rate for Payer: Adventist Health Commercial |
$71.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.52
|
| Rate for Payer: Blue Shield of California Commercial |
$225.92
|
| Rate for Payer: Blue Shield of California EPN |
$142.36
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Central Health Plan Commercial |
$286.88
|
| Rate for Payer: Cigna of CA HMO |
$229.50
|
| Rate for Payer: Cigna of CA PPO |
$265.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.27
|
| Rate for Payer: EPIC Health Plan Senior |
$56.18
|
| Rate for Payer: Galaxy Health WC |
$304.81
|
| Rate for Payer: Global Benefits Group Commercial |
$215.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.43
|
| Rate for Payer: Multiplan Commercial |
$268.95
|
| Rate for Payer: Networks By Design Commercial |
$233.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.07
|
| Rate for Payer: Prime Health Services Commercial |
$304.81
|
| Rate for Payer: Prime Health Services Medicare |
$54.13
|
| Rate for Payer: Riverside University Health System MISP |
$56.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.36
|
| Rate for Payer: United Healthcare All Other HMO |
$41.36
|
| Rate for Payer: United Healthcare HMO Rider |
$41.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
IP
|
$358.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$322.74 |
| Rate for Payer: Adventist Health Commercial |
$71.72
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Central Health Plan Commercial |
$286.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.44
|
| Rate for Payer: EPIC Health Plan Senior |
$143.44
|
| Rate for Payer: Galaxy Health WC |
$304.81
|
| Rate for Payer: Global Benefits Group Commercial |
$215.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.72
|
| Rate for Payer: Multiplan Commercial |
$268.95
|
| Rate for Payer: Networks By Design Commercial |
$233.09
|
| Rate for Payer: Prime Health Services Commercial |
$304.81
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$204.61 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.61
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$22.74
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.70
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$21.91
|
| Rate for Payer: Riverside University Health System MISP |
$22.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.74
|
| Rate for Payer: United Healthcare All Other HMO |
$16.74
|
| Rate for Payer: United Healthcare HMO Rider |
$16.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Vantage Medical Group Senior |
$20.67
|
|
