|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
IP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.73 |
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Central Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.44
|
| Rate for Payer: Galaxy Health WC |
$24.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: Networks By Design Commercial |
$18.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.30
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
IP
|
$16.41
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$14.77 |
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Central Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: Galaxy Health WC |
$13.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$12.31
|
| Rate for Payer: Networks By Design Commercial |
$10.67
|
| Rate for Payer: Prime Health Services Commercial |
$13.95
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
OP
|
$16.41
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$74.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.97
|
| Rate for Payer: Blue Distinction Transplant |
$9.85
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.98
|
| Rate for Payer: Caremore Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Central Health Plan Commercial |
$13.13
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$12.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Media |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$13.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: InnovAge PACE Commercial |
$12.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$12.31
|
| Rate for Payer: Networks By Design Commercial |
$10.67
|
| Rate for Payer: Prime Health Services Commercial |
$13.95
|
| Rate for Payer: Prime Health Services Medicare |
$8.95
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$141.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.25
|
| Rate for Payer: Blue Distinction Transplant |
$16.27
|
| Rate for Payer: Blue Shield of California Commercial |
$16.75
|
| Rate for Payer: Blue Shield of California EPN |
$13.18
|
| Rate for Payer: Caremore Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Media |
$27.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: InnovAge PACE Commercial |
$40.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$357.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$51.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.54
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Caremore Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.60
|
| Rate for Payer: Dignity Health Media |
$51.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.07
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: InnovAge PACE Commercial |
$76.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.43
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$54.13
|
| Rate for Payer: Riverside University Health System MISP |
$56.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.36
|
| Rate for Payer: United Healthcare All Other HMO |
$41.36
|
| Rate for Payer: United Healthcare HMO Rider |
$41.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$147.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.32
|
| Rate for Payer: Blue Distinction Transplant |
$15.61
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Caremore Medicare Advantage |
$16.59
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.81
|
| Rate for Payer: Cigna of CA HMO |
$16.65
|
| Rate for Payer: Cigna of CA PPO |
$19.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.88
|
| Rate for Payer: Dignity Health Media |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$22.11
|
| Rate for Payer: Global Benefits Group Commercial |
$15.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.59
|
| Rate for Payer: InnovAge PACE Commercial |
$24.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$19.51
|
| Rate for Payer: Networks By Design Commercial |
$16.91
|
| Rate for Payer: Prime Health Services Commercial |
$22.11
|
| Rate for Payer: Prime Health Services Medicare |
$17.59
|
| Rate for Payer: Riverside University Health System MISP |
$18.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO |
$13.44
|
| Rate for Payer: United Healthcare HMO Rider |
$13.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Vantage Medical Group Senior |
$16.59
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.11
|
| Rate for Payer: Global Benefits Group Commercial |
$15.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.51
|
| Rate for Payer: Networks By Design Commercial |
$16.91
|
| Rate for Payer: Prime Health Services Commercial |
$22.11
|
|
|
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: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 PROBE SET COUNT
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,505.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,505.45
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.72
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Caremore Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Media |
$21.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| 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: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 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 |
$152.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$26.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.04
|
| 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 |
$152.93
|
| Rate for Payer: Blue Distinction Transplant |
$16.01
|
| Rate for Payer: Blue Shield of California Commercial |
$16.49
|
| Rate for Payer: Blue Shield of California EPN |
$12.97
|
| Rate for Payer: Caremore Medicare Advantage |
$26.69
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$12.01
|
| 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 |
$40.04
|
| Rate for Payer: Dignity Health Media |
$26.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$20.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.69
|
| Rate for Payer: InnovAge PACE Commercial |
$40.04
|
| 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: 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: Vantage Medical Group Commercial/Exchange |
$40.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Vantage Medical Group Senior |
$26.69
|
|
|
HC SOM PROINSULIN
|
Facility
|
IP
|
$26.69
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$24.02 |
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Central Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 |
$207.60
|
| Rate for Payer: Blue Distinction Transplant |
$11.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.24
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| 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 Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$14.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.02
|
| 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: 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: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
OP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$201.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.23
|
| 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 |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$134.15
|
| Rate for Payer: Blue Shield of California Commercial |
$138.17
|
| Rate for Payer: Blue Shield of California EPN |
$108.66
|
| Rate for Payer: Caremore Medicare Advantage |
$12.01
|
| Rate for Payer: Cash Price |
$100.61
|
| Rate for Payer: Cash Price |
$100.61
|
| 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 Media |
$12.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$167.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.82
|
| 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 |
$167.68
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| 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: Vantage Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.01
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
IP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$201.22 |
| Rate for Payer: Cash Price |
$100.61
|
| Rate for Payer: Central Health Plan Commercial |
$178.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$44.72
|
| Rate for Payer: Multiplan Commercial |
$167.68
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$155.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.74
|
| 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 |
$155.03
|
| Rate for Payer: Blue Distinction Transplant |
$14.93
|
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California EPN |
$12.09
|
| Rate for Payer: Caremore Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| 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 |
$26.74
|
| Rate for Payer: Dignity Health Media |
$17.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$18.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: InnovAge PACE Commercial |
$26.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.12
|
| 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: 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 |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 S AG
|
Facility
|
OP
|
$21.95
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$136.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| 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 |
$136.03
|
| Rate for Payer: Blue Distinction Transplant |
$13.17
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$10.67
|
| Rate for Payer: Caremore Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Central Health Plan Commercial |
$17.56
|
| Rate for Payer: Cigna of CA HMO |
$14.05
|
| Rate for Payer: Cigna of CA PPO |
$16.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Media |
$15.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$18.66
|
| Rate for Payer: Global Benefits Group Commercial |
$13.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.28
|
| 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 |
$14.64
|
| 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 |
$4.39
|
| 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 |
$16.46
|
| Rate for Payer: Networks By Design Commercial |
$14.27
|
| Rate for Payer: Prime Health Services Commercial |
$18.66
|
| 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 |
$13.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.17
|
| 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: 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
|
$21.95
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Central Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: Galaxy Health WC |
$18.66
|
| Rate for Payer: Global Benefits Group Commercial |
$13.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.39
|
| Rate for Payer: Multiplan Commercial |
$16.46
|
| Rate for Payer: Networks By Design Commercial |
$14.27
|
| Rate for Payer: Prime Health Services Commercial |
$18.66
|
|
|
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 |
$136.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| 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 |
$136.03
|
| Rate for Payer: Blue Distinction Transplant |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.91
|
| Rate for Payer: Caremore Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| 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 Media |
$15.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$21.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.28
|
| 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: 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: 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: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: Cash Price |
$1.86
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$32.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| 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 |
$32.62
|
| Rate for Payer: Blue Distinction Transplant |
$2.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.01
|
| Rate for Payer: Caremore Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cash Price |
$1.86
|
| 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 Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.06
|
| 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: 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: 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
|
|
