|
HC PROTEIN ELECT CSF/URINE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.55
|
| 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 |
$45.52
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| 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 |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| 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 |
$50.02
|
| 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 |
$15.00
|
| 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 |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.83
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| 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 |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other 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 PROTEIN ELECT SERUM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.87
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: InnovAge PACE Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.74
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$11.38
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC PROTEIN TOTAL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| 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 |
$26.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.41
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.09
|
| 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 |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| 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 |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| 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 |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| 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 |
$26.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.41
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.09
|
| 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 |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| 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 |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| 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 |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PROTEIN URINE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC PROTEIN URINE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| 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 |
$23.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| 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 |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| 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 |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN URINE 24 HOURS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC PROTEIN URINE 24 HOURS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| 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 |
$23.67
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| 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 |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| 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 |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.54
|
| 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 |
$13.54
|
| Rate for Payer: Blue Shield of California EPN |
$8.85
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$16.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$18.95
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.07
|
| 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 |
$14.87
|
| 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 |
$4.46
|
| 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 |
$16.73
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$18.95
|
| 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 |
$13.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.38
|
| 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 PROTHROMBIN G20210A MUTATION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$230.19 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$65.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.72
|
| Rate for Payer: Blue Shield of California Commercial |
$99.55
|
| Rate for Payer: Blue Shield of California EPN |
$65.11
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Central Health Plan Commercial |
$131.20
|
| Rate for Payer: Cigna of CA HMO |
$104.96
|
| Rate for Payer: Cigna of CA PPO |
$121.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.68
|
| Rate for Payer: EPIC Health Plan Senior |
$65.69
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.69
|
| Rate for Payer: InnovAge PACE Commercial |
$98.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.02
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$65.69
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
| Rate for Payer: Prime Health Services Medicare |
$69.63
|
| Rate for Payer: Riverside University Health System MISP |
$72.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.21
|
| Rate for Payer: United Healthcare All Other HMO |
$53.21
|
| Rate for Payer: United Healthcare HMO Rider |
$53.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.26
|
| Rate for Payer: Vantage Medical Group Senior |
$65.69
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
IP
|
$97.60
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$43.92
|
| Rate for Payer: Central Health Plan Commercial |
$78.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.04
|
| Rate for Payer: EPIC Health Plan Senior |
$39.04
|
| Rate for Payer: Galaxy Health WC |
$82.96
|
| Rate for Payer: Global Benefits Group Commercial |
$58.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$73.20
|
| Rate for Payer: Networks By Design Commercial |
$63.44
|
| Rate for Payer: Prime Health Services Commercial |
$82.96
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
OP
|
$97.60
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$59.24
|
| Rate for Payer: Blue Shield of California EPN |
$38.75
|
| Rate for Payer: Cash Price |
$43.92
|
| Rate for Payer: Cash Price |
$43.92
|
| Rate for Payer: Central Health Plan Commercial |
$78.08
|
| Rate for Payer: Cigna of CA HMO |
$62.46
|
| Rate for Payer: Cigna of CA PPO |
$72.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$82.96
|
| Rate for Payer: Global Benefits Group Commercial |
$58.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: InnovAge PACE Commercial |
$6.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$73.20
|
| Rate for Payer: Networks By Design Commercial |
$63.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.29
|
| Rate for Payer: Prime Health Services Commercial |
$82.96
|
| Rate for Payer: Prime Health Services Medicare |
$4.55
|
| Rate for Payer: Riverside University Health System MISP |
$4.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: InnovAge PACE Commercial |
$6.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.55
|
| Rate for Payer: Riverside University Health System MISP |
$4.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: Vantage Medical Group Senior |
$4.29
|
|
|
HC PROTHROMBIN TIME QUICK
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC PROTON COMPLEX
|
Facility
|
IP
|
$17,511.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$3,502.20 |
| Max. Negotiated Rate |
$15,759.90 |
| Rate for Payer: Adventist Health Commercial |
$3,502.20
|
| Rate for Payer: Cash Price |
$7,879.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,008.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,004.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,004.40
|
| Rate for Payer: Galaxy Health WC |
$14,884.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,506.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,759.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,679.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,671.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,839.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,502.20
|
| Rate for Payer: Multiplan Commercial |
$13,133.25
|
| Rate for Payer: Networks By Design Commercial |
$11,382.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,884.35
|
|
|
HC PROTON COMPLEX
|
Facility
|
OP
|
$17,511.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$180,381.00 |
| Rate for Payer: Adventist Health Commercial |
$3,502.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,995.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,695.84
|
| Rate for Payer: Blue Shield of California Commercial |
$10,629.18
|
| Rate for Payer: Blue Shield of California EPN |
$6,951.87
|
| Rate for Payer: Cash Price |
$7,879.95
|
| Rate for Payer: Cash Price |
$7,879.95
|
| Rate for Payer: Cash Price |
$7,879.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,008.80
|
| Rate for Payer: Cigna of CA HMO |
$10,506.60
|
| Rate for Payer: Cigna of CA PPO |
$10,506.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$14,884.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,506.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,759.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: InnovAge PACE Commercial |
$2,430.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,679.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,502.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,171.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$13,133.25
|
| Rate for Payer: Networks By Design Commercial |
$10,506.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Prime Health Services Commercial |
$14,884.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,717.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,782.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180,381.00
|
| Rate for Payer: United Healthcare All Other HMO |
$128,681.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122,515.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112,243.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$55,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
OP
|
$16,490.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,620.66 |
| Max. Negotiated Rate |
$138,758.00 |
| Rate for Payer: Adventist Health Commercial |
$3,298.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,529.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,130.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10,009.43
|
| Rate for Payer: Blue Shield of California EPN |
$6,546.53
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,192.00
|
| Rate for Payer: Cigna of CA HMO |
$9,894.00
|
| Rate for Payer: Cigna of CA PPO |
$9,894.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$14,016.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,894.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,841.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: InnovAge PACE Commercial |
$2,430.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,998.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,298.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,171.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$12,367.50
|
| Rate for Payer: Networks By Design Commercial |
$9,894.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Prime Health Services Commercial |
$14,016.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,717.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,782.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$138,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98,984.00
|
| Rate for Payer: United Healthcare HMO Rider |
$94,242.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86,341.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$45,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
IP
|
$16,490.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$3,298.00 |
| Max. Negotiated Rate |
$14,841.00 |
| Rate for Payer: Adventist Health Commercial |
$3,298.00
|
| Rate for Payer: Cash Price |
$7,420.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,192.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,596.00
|
| Rate for Payer: Galaxy Health WC |
$14,016.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,894.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,841.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,998.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,282.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,207.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,298.00
|
| Rate for Payer: Multiplan Commercial |
$12,367.50
|
| Rate for Payer: Networks By Design Commercial |
$10,718.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,016.50
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
OP
|
$12,603.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,519.00 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,754.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,978.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,650.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,003.39
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,082.40
|
| Rate for Payer: Cigna of CA HMO |
$7,561.80
|
| Rate for Payer: Cigna of CA PPO |
$7,561.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1,620.66
|
| Rate for Payer: Galaxy Health WC |
$10,712.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,561.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,342.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,657.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,620.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,620.66
|
| Rate for Payer: InnovAge PACE Commercial |
$2,430.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,406.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,620.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,520.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,171.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,171.68
|
| Rate for Payer: Multiplan Commercial |
$9,452.25
|
| Rate for Payer: Networks By Design Commercial |
$7,561.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,620.66
|
| Rate for Payer: Prime Health Services Commercial |
$10,712.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,717.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,782.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,430.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.66
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
IP
|
$12,603.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$11,342.70 |
| Rate for Payer: Adventist Health Commercial |
$2,520.60
|
| Rate for Payer: Cash Price |
$5,671.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,082.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,041.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,041.20
|
| Rate for Payer: Galaxy Health WC |
$10,712.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,561.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,342.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,801.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,801.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,520.60
|
| Rate for Payer: Multiplan Commercial |
$9,452.25
|
| Rate for Payer: Networks By Design Commercial |
$8,191.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,712.55
|
|
