|
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 |
$208.81 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.00
|
| 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 HMO/PPO |
$208.81
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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: Heritage Provider Network Commercial/Senior |
$33.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.88
|
| 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 |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.70
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| 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
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
IP
|
$18.74
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Galaxy Health WC |
$15.93
|
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.93
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
OP
|
$18.74
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.64
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cigna of CA HMO |
$11.99
|
| Rate for Payer: Cigna of CA PPO |
$13.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.25
|
| Rate for Payer: Galaxy Health WC |
$15.93
|
| Rate for Payer: Global Benefits Group Commercial |
$11.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO |
$13.44
|
| Rate for Payer: United Healthcare HMO Rider |
$13.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Vantage Medical Group Senior |
$16.59
|
|
|
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 |
$1,751.12 |
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| 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
|
$51.45
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$177.89 |
| Rate for Payer: Adventist Health Commercial |
$10.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.15
|
| 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 |
$177.89
|
| Rate for Payer: Blue Shield of California Commercial |
$23.72
|
| Rate for Payer: Blue Shield of California Commercial |
$35.86
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cigna of CA HMO |
$32.93
|
| Rate for Payer: Cigna of CA PPO |
$38.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.04
|
| Rate for Payer: EPIC Health Plan Senior |
$29.36
|
| Rate for Payer: Galaxy Health WC |
$43.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$32.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.35
|
| 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 |
$41.16
|
| Rate for Payer: Networks By Design Commercial |
$33.44
|
| Rate for Payer: Prime Health Services Commercial |
$43.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.87
|
| 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
|
$51.45
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$10.29
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.58
|
| Rate for Payer: EPIC Health Plan Senior |
$20.58
|
| Rate for Payer: Galaxy Health WC |
$43.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.35
|
| Rate for Payer: Multiplan Commercial |
$41.16
|
| Rate for Payer: Networks By Design Commercial |
$33.44
|
| Rate for Payer: Prime Health Services Commercial |
$43.73
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$10.94
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
OP
|
$13.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$189.84 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| 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 |
$189.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$9.53
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| 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 |
$10.94
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| 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 PROTEINASE 3 AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| 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 |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| 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 |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.51
|
| 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 Foundation Hospitals Commercial/Self Funded |
$141.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.91
|
| 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 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 |
$99.97
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$103.07
|
| Rate for Payer: Blue Shield of California Commercial |
$155.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$141.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.81
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.68
|
| 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 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 |
$180.32 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.29
|
| 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 |
$180.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Senior |
$19.61
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.96
|
| 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 S AG
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$158.23 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.43
|
| 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 |
$158.23
|
| Rate for Payer: Blue Shield of California Commercial |
$11.73
|
| Rate for Payer: Blue Shield of California Commercial |
$17.74
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cigna of CA HMO |
$16.29
|
| Rate for Payer: Cigna of CA PPO |
$18.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$21.63
|
| Rate for Payer: Global Benefits Group Commercial |
$15.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.11
|
| 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 |
$20.36
|
| Rate for Payer: Networks By Design Commercial |
$16.54
|
| Rate for Payer: Prime Health Services Commercial |
$21.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.27
|
| 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
|
$25.45
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.18
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$21.63
|
| Rate for Payer: Global Benefits Group Commercial |
$15.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.11
|
| Rate for Payer: Multiplan Commercial |
$20.36
|
| Rate for Payer: Networks By Design Commercial |
$16.54
|
| Rate for Payer: Prime Health Services Commercial |
$21.63
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$158.23 |
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.43
|
| 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 |
$158.23
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| 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 |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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, 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 |
$37.94 |
| Rate for Payer: Cigna of CA PPO |
$3.06
|
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| 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 |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.89
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| 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 |
$37.94 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| 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 |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| 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
|
IP
|
$126.77
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Adventist Health Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.71
|
| Rate for Payer: EPIC Health Plan Senior |
$50.71
|
| Rate for Payer: Galaxy Health WC |
$107.75
|
| Rate for Payer: Global Benefits Group Commercial |
$76.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$101.42
|
| Rate for Payer: Networks By Design Commercial |
$82.40
|
| Rate for Payer: Prime Health Services Commercial |
$107.75
|
|
