|
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 |
$9.35
|
| Rate for Payer: Cash Price |
$9.35
|
| 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
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
|
|
HC PROTEIN URINE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
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 |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| 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
|
$39.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
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 |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| 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
|
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 |
$12.27
|
| Rate for Payer: Cash Price |
$12.27
|
| 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 PROTEIN URINE RANDOM
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8.92
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.73
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Prime Health Services Commercial |
$18.95
|
|
|
HC PROTHROMBIN G20210A MUTATION
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Cash Price |
$90.20
|
| Rate for Payer: Central Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Senior |
$65.60
|
| 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: 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 |
$101.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
|
|
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 |
$90.20
|
| Rate for Payer: Cash Price |
$90.20
|
| 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 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 |
$53.68
|
| 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 |
$53.68
|
| Rate for Payer: Cash Price |
$53.68
|
| 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
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| 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 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 |
$9,631.05
|
| 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 |
$9,631.05
|
| Rate for Payer: Cash Price |
$9,631.05
|
| Rate for Payer: Cash Price |
$9,631.05
|
| 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 |
$9,069.50
|
| Rate for Payer: Cash Price |
$9,069.50
|
| Rate for Payer: Cash Price |
$9,069.50
|
| 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 |
$9,069.50
|
| 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
|
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 |
$6,931.65
|
| 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
|
|
|
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 |
$6,931.65
|
| Rate for Payer: Cash Price |
$6,931.65
|
| Rate for Payer: Cash Price |
$6,931.65
|
| 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 WO COMPENSATOR
|
Facility
|
OP
|
$8,684.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$101,753.00 |
| Rate for Payer: Adventist Health Commercial |
$1,736.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,965.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,808.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5,271.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,447.55
|
| Rate for Payer: Cash Price |
$4,776.20
|
| Rate for Payer: Cash Price |
$4,776.20
|
| Rate for Payer: Cash Price |
$4,776.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,947.20
|
| Rate for Payer: Cigna of CA HMO |
$5,210.40
|
| Rate for Payer: Cigna of CA PPO |
$5,210.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$735.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$7,381.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,210.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,815.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$6,513.00
|
| Rate for Payer: Networks By Design Commercial |
$5,210.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$735.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,381.40
|
| Rate for Payer: Prime Health Services Medicare |
$779.10
|
| Rate for Payer: Riverside University Health System MISP |
$808.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$72,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63,320.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$25,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$735.00
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$8,684.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,736.80 |
| Max. Negotiated Rate |
$7,815.60 |
| Rate for Payer: Adventist Health Commercial |
$1,736.80
|
| Rate for Payer: Cash Price |
$4,776.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,947.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,473.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,473.60
|
| Rate for Payer: Galaxy Health WC |
$7,381.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,210.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,815.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,792.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,308.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,375.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.80
|
| Rate for Payer: Multiplan Commercial |
$6,513.00
|
| Rate for Payer: Networks By Design Commercial |
$5,644.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,381.40
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$1,527.30 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,030.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$380.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,030.08
|
| Rate for Payer: Blue Shield of California EPN |
$673.71
|
| Rate for Payer: Cash Price |
$933.35
|
| Rate for Payer: Cash Price |
$933.35
|
| Rate for Payer: Cash Price |
$933.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.08
|
| Rate for Payer: Cigna of CA PPO |
$1,255.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,527.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,272.75
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,018.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,018.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$339.40 |
| Max. Negotiated Rate |
$1,527.30 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Cash Price |
$933.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$678.80
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,527.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,050.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.40
|
| Rate for Payer: Multiplan Commercial |
$1,272.75
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
|
|
HC PROVOX LARYNGECTOMY TUBE 12/55
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.80 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Adventist Health Commercial |
$143.80
|
| Rate for Payer: Blue Shield of California Commercial |
$555.79
|
| Rate for Payer: Blue Shield of California EPN |
$362.38
|
| Rate for Payer: Cash Price |
$395.45
|
| Rate for Payer: Central Health Plan Commercial |
$575.20
|
| Rate for Payer: Cigna of CA HMO |
$503.30
|
| Rate for Payer: Cigna of CA PPO |
$503.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$287.60
|
| Rate for Payer: Galaxy Health WC |
$611.15
|
| Rate for Payer: Global Benefits Group Commercial |
$431.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$647.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$479.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.80
|
| Rate for Payer: Multiplan Commercial |
$539.25
|
| Rate for Payer: Networks By Design Commercial |
$467.35
|
| Rate for Payer: Prime Health Services Commercial |
$611.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.84
|
| Rate for Payer: United Healthcare All Other HMO |
$262.65
|
| Rate for Payer: United Healthcare HMO Rider |
$256.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.47
|
|
