|
HC SOM PROBE SET COUNT
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,675.72 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.72
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM PROBE SET COUNT
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM PROINSULIN
|
Facility
|
OP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$170.23 |
| Rate for Payer: Adventist Health Commercial |
$5.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.23
|
| Rate for Payer: Blue Shield of California Commercial |
$17.86
|
| Rate for Payer: Blue Shield of California EPN |
$11.80
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cigna of CA HMO |
$17.08
|
| Rate for Payer: Cigna of CA PPO |
$19.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.03
|
| Rate for Payer: EPIC Health Plan Senior |
$26.69
|
| Rate for Payer: Galaxy Health WC |
$22.69
|
| Rate for Payer: Global Benefits Group Commercial |
$16.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$21.35
|
| Rate for Payer: Networks By Design Commercial |
$17.35
|
| Rate for Payer: Prime Health Services Commercial |
$22.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.62
|
| Rate for Payer: United Healthcare All Other HMO |
$21.62
|
| Rate for Payer: United Healthcare HMO Rider |
$21.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Vantage Medical Group Senior |
$26.69
|
|
|
HC SOM PROINSULIN
|
Facility
|
IP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$22.69 |
| Rate for Payer: Adventist Health Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$22.69
|
| Rate for Payer: Global Benefits Group Commercial |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.41
|
| Rate for Payer: Multiplan Commercial |
$21.35
|
| Rate for Payer: Networks By Design Commercial |
$17.35
|
| Rate for Payer: Prime Health Services Commercial |
$22.69
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$181.67 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.67
|
| Rate for Payer: Blue Shield of California Commercial |
$8.88
|
| Rate for Payer: Blue Shield of California EPN |
$5.87
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
IP
|
$19.01
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.16
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.21
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.16
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
OP
|
$19.01
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12.72
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$16.16
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.21
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
OP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$190.04 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$149.58
|
| Rate for Payer: Blue Shield of California EPN |
$98.82
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cigna of CA HMO |
$143.09
|
| Rate for Payer: Cigna of CA PPO |
$165.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.21
|
| Rate for Payer: EPIC Health Plan Senior |
$12.01
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.09
|
| Rate for Payer: Multiplan Commercial |
$178.86
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.73
|
| Rate for Payer: United Healthcare All Other HMO |
$9.73
|
| Rate for Payer: United Healthcare HMO Rider |
$9.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.01
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
IP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$190.04 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.43
|
| Rate for Payer: EPIC Health Plan Senior |
$89.43
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.66
|
| Rate for Payer: Multiplan Commercial |
$178.86
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$172.56 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.56
|
| Rate for Payer: Blue Shield of California Commercial |
$16.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cigna of CA HMO |
$15.92
|
| Rate for Payer: Cigna of CA PPO |
$18.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$19.90
|
| Rate for Payer: Networks By Design Commercial |
$16.17
|
| Rate for Payer: Prime Health Services Commercial |
$21.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Senior |
$9.95
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$19.90
|
| Rate for Payer: Networks By Design Commercial |
$16.17
|
| Rate for Payer: Prime Health Services Commercial |
$21.15
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$151.41 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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 |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| 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 |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
OP
|
$28.63
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$151.41 |
| Rate for Payer: Adventist Health Commercial |
$5.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.65
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cigna of CA HMO |
$18.32
|
| Rate for Payer: Cigna of CA PPO |
$21.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$24.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$22.90
|
| Rate for Payer: Networks By Design Commercial |
$18.61
|
| Rate for Payer: Prime Health Services Commercial |
$24.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
IP
|
$28.63
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Adventist Health Commercial |
$5.73
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$22.90
|
| Rate for Payer: Networks By Design Commercial |
$18.61
|
| Rate for Payer: Prime Health Services Commercial |
$24.34
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$3.28
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
OP
|
$355.71
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Adventist Health Commercial |
$71.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$237.97
|
| Rate for Payer: Blue Shield of California EPN |
$157.22
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Cigna of CA HMO |
$227.65
|
| Rate for Payer: Cigna of CA PPO |
$263.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$302.35
|
| Rate for Payer: Global Benefits Group Commercial |
$213.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$284.57
|
| Rate for Payer: Networks By Design Commercial |
$231.21
|
| Rate for Payer: Prime Health Services Commercial |
$302.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$355.71
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Adventist Health Commercial |
$71.14
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.28
|
| Rate for Payer: EPIC Health Plan Senior |
$142.28
|
| Rate for Payer: Galaxy Health WC |
$302.35
|
| Rate for Payer: Global Benefits Group Commercial |
$213.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.37
|
| Rate for Payer: Multiplan Commercial |
$284.57
|
| Rate for Payer: Networks By Design Commercial |
$231.21
|
| Rate for Payer: Prime Health Services Commercial |
$302.35
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$169.57 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.57
|
| Rate for Payer: Blue Shield of California Commercial |
$42.14
|
| Rate for Payer: Blue Shield of California EPN |
$27.84
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.54
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$50.39
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO |
$31.50
|
| Rate for Payer: United Healthcare HMO Rider |
$31.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.54
|
| Rate for Payer: Vantage Medical Group Senior |
$53.54
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$53.54 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.54
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.39
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.54
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$181.67 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.67
|
| Rate for Payer: Blue Shield of California Commercial |
$82.55
|
| Rate for Payer: Blue Shield of California EPN |
$54.54
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cigna of CA HMO |
$78.98
|
| Rate for Payer: Cigna of CA PPO |
$91.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$98.72
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
