|
HC SOM PROBE SET COUNT
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM PROINSULIN
|
Facility
|
IP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$24.02 |
| Rate for Payer: Adventist Health Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Central Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$10.68
|
| Rate for Payer: Galaxy Health WC |
$22.69
|
| Rate for Payer: Global Benefits Group Commercial |
$16.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.34
|
| Rate for Payer: Multiplan Commercial |
$20.02
|
| Rate for Payer: Networks By Design Commercial |
$17.35
|
| Rate for Payer: Prime Health Services Commercial |
$22.69
|
|
|
HC SOM PROINSULIN
|
Facility
|
OP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Adventist Health Commercial |
$5.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.45
|
| Rate for Payer: Blue Shield of California Commercial |
$16.20
|
| Rate for Payer: Blue Shield of California EPN |
$10.60
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Central Health Plan Commercial |
$21.35
|
| Rate for Payer: Cigna of CA HMO |
$17.08
|
| Rate for Payer: Cigna of CA PPO |
$19.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.03
|
| Rate for Payer: EPIC Health Plan Senior |
$26.69
|
| Rate for Payer: Galaxy Health WC |
$22.69
|
| Rate for Payer: Global Benefits Group Commercial |
$16.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.69
|
| Rate for Payer: InnovAge PACE Commercial |
$40.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$20.02
|
| Rate for Payer: Networks By Design Commercial |
$17.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.69
|
| Rate for Payer: Prime Health Services Commercial |
$22.69
|
| Rate for Payer: Prime Health Services Medicare |
$28.29
|
| Rate for Payer: Riverside University Health System MISP |
$29.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.62
|
| Rate for Payer: United Healthcare All Other HMO |
$21.62
|
| Rate for Payer: United Healthcare HMO Rider |
$21.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Vantage Medical Group Senior |
$26.69
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.16
|
| Rate for Payer: Blue Shield of California Commercial |
$8.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Central Health Plan Commercial |
$10.62
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$9.96
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.95 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Central Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$9.96
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
IP
|
$19.01
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.11 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Central Health Plan Commercial |
$15.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.16
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.26
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.16
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
OP
|
$19.01
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.55
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Central Health Plan Commercial |
$15.21
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$16.16
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$14.26
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$16.16
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
IP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$201.22 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Central Health Plan Commercial |
$178.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.43
|
| Rate for Payer: EPIC Health Plan Senior |
$89.43
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.72
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
OP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$201.22 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$135.71
|
| Rate for Payer: Blue Shield of California EPN |
$88.76
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Central Health Plan Commercial |
$178.86
|
| Rate for Payer: Cigna of CA HMO |
$143.09
|
| Rate for Payer: Cigna of CA PPO |
$165.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.21
|
| Rate for Payer: EPIC Health Plan Senior |
$12.01
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.01
|
| Rate for Payer: InnovAge PACE Commercial |
$18.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.09
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.01
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
| Rate for Payer: Prime Health Services Medicare |
$12.73
|
| Rate for Payer: Riverside University Health System MISP |
$13.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.73
|
| Rate for Payer: United Healthcare All Other HMO |
$9.73
|
| Rate for Payer: United Healthcare HMO Rider |
$9.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.01
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Central Health Plan Commercial |
$19.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Senior |
$9.95
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
| Rate for Payer: Networks By Design Commercial |
$16.17
|
| Rate for Payer: Prime Health Services Commercial |
$21.15
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.79
|
| Rate for Payer: Blue Shield of California Commercial |
$15.10
|
| Rate for Payer: Blue Shield of California EPN |
$9.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Central Health Plan Commercial |
$19.90
|
| Rate for Payer: Cigna of CA HMO |
$15.92
|
| Rate for Payer: Cigna of CA PPO |
$18.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: InnovAge PACE Commercial |
$26.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
| Rate for Payer: Networks By Design Commercial |
$16.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.83
|
| Rate for Payer: Prime Health Services Commercial |
$21.15
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$111.52 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.63
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: InnovAge PACE Commercial |
$22.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.32
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
OP
|
$28.63
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$111.52 |
| Rate for Payer: Adventist Health Commercial |
$5.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.63
|
| Rate for Payer: Blue Shield of California Commercial |
$17.38
|
| Rate for Payer: Blue Shield of California EPN |
$11.37
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Cigna of CA HMO |
$18.32
|
| Rate for Payer: Cigna of CA PPO |
$21.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$24.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: InnovAge PACE Commercial |
$22.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$21.47
|
| Rate for Payer: Networks By Design Commercial |
$18.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.32
|
| Rate for Payer: Prime Health Services Commercial |
$24.34
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
IP
|
$28.63
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$25.77 |
| Rate for Payer: Adventist Health Commercial |
$5.73
|
| Rate for Payer: Cash Price |
$28.63
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.73
|
| Rate for Payer: Multiplan Commercial |
$21.47
|
| Rate for Payer: Networks By Design Commercial |
$18.61
|
| Rate for Payer: Prime Health Services Commercial |
$24.34
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.51
|
| 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 Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| 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 Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.28
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
OP
|
$355.71
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$320.14 |
| Rate for Payer: Adventist Health Commercial |
$71.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$216.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$215.92
|
| Rate for Payer: Blue Shield of California EPN |
$141.22
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Central Health Plan Commercial |
$284.57
|
| Rate for Payer: Cigna of CA HMO |
$227.65
|
| Rate for Payer: Cigna of CA PPO |
$263.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$302.35
|
| Rate for Payer: Global Benefits Group Commercial |
$213.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: InnovAge PACE Commercial |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$266.78
|
| Rate for Payer: Networks By Design Commercial |
$231.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$302.35
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$355.71
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$320.14 |
| Rate for Payer: Adventist Health Commercial |
$71.14
|
| Rate for Payer: Cash Price |
$355.71
|
| Rate for Payer: Central Health Plan Commercial |
$284.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.28
|
| Rate for Payer: EPIC Health Plan Senior |
$142.28
|
| Rate for Payer: Galaxy Health WC |
$302.35
|
| Rate for Payer: Global Benefits Group Commercial |
$213.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.14
|
| Rate for Payer: Multiplan Commercial |
$266.78
|
| Rate for Payer: Networks By Design Commercial |
$231.21
|
| Rate for Payer: Prime Health Services Commercial |
$302.35
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$124.89 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.35
|
| Rate for Payer: Blue Shield of California Commercial |
$38.23
|
| Rate for Payer: Blue Shield of California EPN |
$25.01
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Central Health Plan Commercial |
$50.39
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.54
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.69
|
| Rate for Payer: InnovAge PACE Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.54
|
| Rate for Payer: Riverside University Health System MISP |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO |
$31.50
|
| Rate for Payer: United Healthcare HMO Rider |
$31.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.54
|
| Rate for Payer: Vantage Medical Group Senior |
$53.54
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$56.69 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Central Health Plan Commercial |
$50.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.54
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.54
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.16
|
| Rate for Payer: Blue Shield of California Commercial |
$74.90
|
| Rate for Payer: Blue Shield of California EPN |
$48.99
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Central Health Plan Commercial |
$98.72
|
| Rate for Payer: Cigna of CA HMO |
$78.98
|
| Rate for Payer: Cigna of CA PPO |
$91.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$111.06 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Central Health Plan Commercial |
$98.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.36
|
| Rate for Payer: EPIC Health Plan Senior |
$49.36
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.68
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
|
