|
HC PROTEIN ELECT CSF/URINE
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$139.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$139.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.20
|
| Rate for Payer: Blue Shield of California Commercial |
$169.93
|
| Rate for Payer: Blue Shield of California EPN |
$112.27
|
| Rate for Payer: Cash Price |
$139.70
|
| Rate for Payer: Cash Price |
$139.70
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC PROTEIN TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PROTEIN TOTAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| 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 |
$36.17
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| 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 |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| 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 |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 PROTEIN TOTAL SPE ONLY
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| 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 |
$36.17
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| 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 |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| 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 |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 PROTEIN URINE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.74
|
| 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 |
$78.27
|
| Rate for Payer: Blue Shield of California EPN |
$51.71
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| 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 |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| 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 |
$78.04
|
| 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 |
$28.08
|
| 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 |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| 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 PROTEIN URINE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.54
|
| Rate for Payer: Blue Shield of California Commercial |
$413.44
|
| Rate for Payer: Blue Shield of California EPN |
$273.16
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna of CA HMO |
$395.52
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.68
|
| Rate for Payer: EPIC Health Plan Senior |
$65.69
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.02
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.21
|
| Rate for Payer: United Healthcare All Other HMO |
$53.21
|
| Rate for Payer: United Healthcare HMO Rider |
$53.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
IP
|
$97.60
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$82.96 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.04
|
| Rate for Payer: EPIC Health Plan Senior |
$39.04
|
| Rate for Payer: Galaxy Health WC |
$82.96
|
| Rate for Payer: Global Benefits Group Commercial |
$58.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$78.08
|
| Rate for Payer: Networks By Design Commercial |
$63.44
|
| Rate for Payer: Prime Health Services Commercial |
$82.96
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
OP
|
$97.60
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$82.96 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.90
|
| Rate for Payer: Blue Shield of California Commercial |
$65.29
|
| Rate for Payer: Blue Shield of California EPN |
$43.14
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cigna of CA HMO |
$62.46
|
| Rate for Payer: Cigna of CA PPO |
$72.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$82.96
|
| Rate for Payer: Global Benefits Group Commercial |
$58.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$78.08
|
| Rate for Payer: Networks By Design Commercial |
$63.44
|
| Rate for Payer: Prime Health Services Commercial |
$82.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.62
|
| Rate for Payer: Blue Shield of California EPN |
$53.92
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTON COMPLEX
|
Facility
|
IP
|
$11,604.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,320.80 |
| Max. Negotiated Rate |
$9,863.40 |
| Rate for Payer: Adventist Health Commercial |
$2,320.80
|
| Rate for Payer: Cash Price |
$6,382.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,641.60
|
| Rate for Payer: Galaxy Health WC |
$9,863.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,962.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,739.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,421.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,182.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.96
|
| Rate for Payer: Multiplan Commercial |
$9,283.20
|
| Rate for Payer: Networks By Design Commercial |
$7,542.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,863.40
|
|
|
HC PROTON COMPLEX
|
Facility
|
OP
|
$11,604.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$180,381.00 |
| Rate for Payer: Adventist Health Commercial |
$2,320.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,721.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7,101.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,688.02
|
| Rate for Payer: Cash Price |
$6,382.20
|
| Rate for Payer: Cash Price |
$6,382.20
|
| Rate for Payer: Cash Price |
$6,382.20
|
| Rate for Payer: Cigna of CA HMO |
$6,962.40
|
| Rate for Payer: Cigna of CA PPO |
$6,962.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$9,863.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,962.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,739.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,042.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$9,283.20
|
| Rate for Payer: Networks By Design Commercial |
$6,962.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,863.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180,381.00
|
| Rate for Payer: United Healthcare All Other HMO |
$128,681.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122,515.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112,243.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$55,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
OP
|
$10,928.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$138,758.00 |
| Rate for Payer: Adventist Health Commercial |
$2,185.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,572.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,329.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6,687.94
|
| Rate for Payer: Blue Shield of California EPN |
$4,414.91
|
| Rate for Payer: Cash Price |
$6,010.40
|
| Rate for Payer: Cash Price |
$6,010.40
|
| Rate for Payer: Cash Price |
$6,010.40
|
| Rate for Payer: Cigna of CA HMO |
$6,556.80
|
| Rate for Payer: Cigna of CA PPO |
$6,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$9,288.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,556.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,622.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,042.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$8,742.40
|
| Rate for Payer: Networks By Design Commercial |
$6,556.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,288.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$138,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98,984.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94,242.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86,341.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$45,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
IP
|
$10,928.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,185.60 |
| Max. Negotiated Rate |
$9,288.80 |
| Rate for Payer: Adventist Health Commercial |
$2,185.60
|
| Rate for Payer: Cash Price |
$6,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,371.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,371.20
|
| Rate for Payer: Galaxy Health WC |
$9,288.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,556.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,288.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,163.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,764.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,622.72
|
| Rate for Payer: Multiplan Commercial |
$8,742.40
|
| Rate for Payer: Networks By Design Commercial |
$7,103.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,288.80
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
OP
|
$8,352.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,837.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5,111.42
|
| Rate for Payer: Blue Shield of California EPN |
$3,374.21
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cigna of CA HMO |
$5,011.20
|
| Rate for Payer: Cigna of CA PPO |
$5,011.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$7,099.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,011.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,570.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,042.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$6,681.60
|
| Rate for Payer: Networks By Design Commercial |
$5,011.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
IP
|
$8,352.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,670.40 |
| Max. Negotiated Rate |
$7,099.20 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,340.80
|
| Rate for Payer: Galaxy Health WC |
$7,099.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,011.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,570.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,182.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,169.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.48
|
| Rate for Payer: Multiplan Commercial |
$6,681.60
|
| Rate for Payer: Networks By Design Commercial |
$5,428.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,099.20
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
OP
|
$5,754.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$1,150.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,332.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3,521.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,324.62
|
| Rate for Payer: Cash Price |
$3,164.70
|
| Rate for Payer: Cash Price |
$3,164.70
|
| Rate for Payer: Cash Price |
$3,164.70
|
| Rate for Payer: Cigna of CA HMO |
$3,452.40
|
| Rate for Payer: Cigna of CA PPO |
$3,452.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$735.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$4,890.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,452.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$735.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$4,603.20
|
| Rate for Payer: Networks By Design Commercial |
$3,452.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$5,754.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,150.80 |
| Max. Negotiated Rate |
$4,890.90 |
| Rate for Payer: Adventist Health Commercial |
$1,150.80
|
| Rate for Payer: Cash Price |
$3,164.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.60
|
| Rate for Payer: Galaxy Health WC |
$4,890.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,452.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,192.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,561.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.96
|
| Rate for Payer: Multiplan Commercial |
$4,603.20
|
| Rate for Payer: Networks By Design Commercial |
$3,740.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.90
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$1,066.75 |
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$823.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$770.70
|
| Rate for Payer: Blue Shield of California Commercial |
$768.06
|
| Rate for Payer: Blue Shield of California EPN |
$507.02
|
| Rate for Payer: Cash Price |
$690.25
|
| Rate for Payer: Cash Price |
$690.25
|
| Rate for Payer: Cash Price |
$690.25
|
| Rate for Payer: Cigna of CA HMO |
$803.20
|
| Rate for Payer: Cigna of CA PPO |
$928.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,066.75
|
| Rate for Payer: Global Benefits Group Commercial |
$753.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: Networks By Design Commercial |
$815.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,066.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$753.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$753.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$1,066.75 |
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Cash Price |
$690.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.00
|
| Rate for Payer: EPIC Health Plan Senior |
$502.00
|
| Rate for Payer: Galaxy Health WC |
$1,066.75
|
| Rate for Payer: Global Benefits Group Commercial |
$753.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$776.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.20
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: Networks By Design Commercial |
$815.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,066.75
|
|
