|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
915350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
905350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
905350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PROTECTOR HEEL HEELMEDIX XL
|
Facility
|
IP
|
$395.04
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901606284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$335.78 |
| Rate for Payer: Adventist Health Commercial |
$79.01
|
| Rate for Payer: Cash Price |
$177.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$276.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.02
|
| Rate for Payer: EPIC Health Plan Senior |
$158.02
|
| Rate for Payer: Galaxy Health WC |
$335.78
|
| Rate for Payer: Global Benefits Group Commercial |
$237.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.81
|
| Rate for Payer: Multiplan Commercial |
$316.03
|
| Rate for Payer: Networks By Design Commercial |
$256.78
|
| Rate for Payer: Prime Health Services Commercial |
$335.78
|
|
|
HC PROTECTOR HEEL HEELMEDIX XL
|
Facility
|
OP
|
$395.04
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901606284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$778.65 |
| Rate for Payer: Adventist Health Commercial |
$79.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$335.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$296.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.50
|
| Rate for Payer: Cash Price |
$177.77
|
| Rate for Payer: Cash Price |
$177.77
|
| Rate for Payer: Cigna of CA HMO |
$252.83
|
| Rate for Payer: Cigna of CA PPO |
$292.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$276.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.02
|
| Rate for Payer: EPIC Health Plan Senior |
$158.02
|
| Rate for Payer: Galaxy Health WC |
$335.78
|
| Rate for Payer: Global Benefits Group Commercial |
$237.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$250.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$276.53
|
| Rate for Payer: Multiplan Commercial |
$316.03
|
| Rate for Payer: Networks By Design Commercial |
$256.78
|
| Rate for Payer: Prime Health Services Commercial |
$335.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.52
|
| Rate for Payer: United Healthcare All Other HMO |
$197.52
|
| Rate for Payer: United Healthcare HMO Rider |
$197.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$335.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.78
|
| Rate for Payer: Vantage Medical Group Senior |
$335.78
|
|
|
HC PROTEINASE AB
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| 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 Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$35.96
|
| Rate for Payer: Blue Shield of California Commercial |
$32.27
|
| Rate for Payer: Blue Shield of California Commercial |
$54.37
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| 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) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| 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 All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| 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 Commercial/Exchange |
$17.30
|
|
|
HC PROTEINASE AB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC PROTEIN BODY FLUID
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900910248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC PROTEIN BODY FLUID
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900910248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
900912012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$142.87 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.87
|
| Rate for Payer: Blue Shield of California Commercial |
$141.99
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$214.68
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$215.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.84
|
| Rate for Payer: EPIC Health Plan Senior |
$15.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.22
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$195.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.55
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.21
|
| Rate for Payer: United Healthcare All Other HMO |
$11.21
|
| Rate for Payer: United Healthcare All Other HMO |
$11.21
|
| Rate for Payer: United Healthcare HMO Rider |
$11.21
|
| Rate for Payer: United Healthcare HMO Rider |
$11.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Vantage Medical Group Senior |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$13.84
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
900912012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$215.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$195.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$181.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC PROTEIN CSF
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900912250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC PROTEIN CSF
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900912250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California Commercial |
$23.70
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
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 |
$114.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.86
|
| 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 CSF/URINE
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.29
|
| 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 Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| 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: 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: Anthem Blue Cross of CA HMO/PPO |
$180.32
|
| Rate for Payer: Blue Shield of California Commercial |
$34.58
|
| Rate for Payer: Blue Shield of California Commercial |
$117.09
|
| Rate for Payer: Blue Shield of California Commercial |
$52.27
|
| Rate for Payer: Blue Shield of California Commercial |
$177.04
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Senior |
$19.61
|
| Rate for Payer: EPIC Health Plan Senior |
$19.61
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| 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) Medi-Cal |
$26.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| 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 All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| 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 Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
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: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| 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 Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.97
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$117.09
|
| Rate for Payer: Blue Shield of California Commercial |
$57.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.04
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.04
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| 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 All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| 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 Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
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 |
$114.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.86
|
| 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 TOTAL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| 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 Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.97
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| 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 Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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 Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| 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 Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
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 |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| 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 INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| 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 |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| 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 |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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
|
|
|
HC PROTEIN TOTAL INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| 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 Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.97
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| 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 Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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 Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| 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 Commercial/Exchange |
$5.50
|
|
|
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 |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| 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 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: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.52
|
| 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 Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| 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: 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: Anthem Blue Cross of CA HMO/PPO |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$53.94
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California Commercial |
$81.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| 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: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| 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) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| 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 All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| 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 Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| 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 |
$52.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| 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
|
|
