|
HC PROTEIN URINE 24 HOURS
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.62
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| 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 |
$3.00
|
| 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 |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| 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 |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: 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
|
$106.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.62
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| 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 |
$3.00
|
| 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 |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| 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 |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: 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
|
$168.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$280.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$65.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.54
|
| 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 |
$280.78
|
| Rate for Payer: Blue Distinction Transplant |
$100.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.82
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Caremore Medicare Advantage |
$65.69
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.54
|
| Rate for Payer: Dignity Health Media |
$65.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.69
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.69
|
| Rate for Payer: InnovAge PACE Commercial |
$98.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| 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 |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| 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 |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$98.54
|
| 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
|
$632.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
900912324
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$421.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.40
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC PROTHROMBIN TIME (POC)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900912025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.44
|
| 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 |
$34.95
|
| Rate for Payer: Blue Distinction Transplant |
$76.80
|
| Rate for Payer: Blue Shield of California Commercial |
$79.10
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Caremore Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.44
|
| Rate for Payer: Dignity Health Media |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: InnovAge PACE Commercial |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| 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 |
$25.60
|
| 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 |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| 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 |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$6.44
|
| 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
|
$13.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.44
|
| 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 |
$34.95
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Caremore Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.44
|
| Rate for Payer: Dignity Health Media |
$4.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.29
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.29
|
| Rate for Payer: InnovAge PACE Commercial |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| 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 |
$2.60
|
| 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 |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| 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 |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$6.44
|
| 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
|
$128.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC PROTON COMPLEX
|
Facility
|
OP
|
$15,883.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,772.43 |
| Max. Negotiated Rate |
$171,221.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,772.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,772.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,252.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,846.83
|
| Rate for Payer: Blue Distinction Transplant |
$9,529.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,815.69
|
| Rate for Payer: Blue Shield of California EPN |
$7,719.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,772.43
|
| Rate for Payer: Cash Price |
$7,147.35
|
| Rate for Payer: Cash Price |
$7,147.35
|
| Rate for Payer: Cash Price |
$7,147.35
|
| Rate for Payer: Central Health Plan Commercial |
$12,706.40
|
| Rate for Payer: Cigna of CA HMO |
$9,529.80
|
| Rate for Payer: Cigna of CA PPO |
$9,529.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Dignity Health Media |
$1,772.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,772.43
|
| Rate for Payer: Galaxy Health WC |
$13,500.55
|
| Rate for Payer: Global Benefits Group Commercial |
$9,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,294.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,912.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,906.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,772.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2,658.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,593.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,176.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,375.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,375.06
|
| Rate for Payer: Multiplan Commercial |
$11,912.25
|
| Rate for Payer: Networks By Design Commercial |
$9,529.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,500.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,878.78
|
| Rate for Payer: Riverside University Health System MISP |
$1,949.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$171,221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122,553.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106,695.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,772.43
|
|
|
HC PROTON COMPLEX
|
Facility
|
IP
|
$15,883.00
|
|
|
Service Code
|
CPT 77525
|
| Hospital Charge Code |
904810920
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$3,176.60 |
| Max. Negotiated Rate |
$14,294.70 |
| Rate for Payer: Cash Price |
$7,147.35
|
| Rate for Payer: Central Health Plan Commercial |
$12,706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,353.20
|
| Rate for Payer: Galaxy Health WC |
$13,500.55
|
| Rate for Payer: Global Benefits Group Commercial |
$9,529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,294.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,593.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,051.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,176.60
|
| Rate for Payer: Multiplan Commercial |
$11,912.25
|
| Rate for Payer: Networks By Design Commercial |
$10,323.95
|
| Rate for Payer: Prime Health Services Commercial |
$13,500.55
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
IP
|
$14,957.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,991.40 |
| Max. Negotiated Rate |
$13,461.30 |
| Rate for Payer: Cash Price |
$6,730.65
|
| Rate for Payer: Central Health Plan Commercial |
$11,965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,982.80
|
| Rate for Payer: Galaxy Health WC |
$12,713.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,974.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,461.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,976.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,698.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,991.40
|
| Rate for Payer: Multiplan Commercial |
$11,217.75
|
| Rate for Payer: Networks By Design Commercial |
$9,722.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,713.45
|
|
|
HC PROTON INTERMEDIATE
|
Facility
|
OP
|
$14,957.00
|
|
|
Service Code
|
CPT 77523
|
| Hospital Charge Code |
904810915
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,772.43 |
| Max. Negotiated Rate |
$131,711.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,772.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,208.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,772.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,829.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,331.05
|
| Rate for Payer: Blue Distinction Transplant |
$8,974.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,243.43
|
| Rate for Payer: Blue Shield of California EPN |
$7,269.10
|
| Rate for Payer: Caremore Medicare Advantage |
$1,772.43
|
| Rate for Payer: Cash Price |
$6,730.65
|
| Rate for Payer: Cash Price |
$6,730.65
|
| Rate for Payer: Cash Price |
$6,730.65
|
| Rate for Payer: Central Health Plan Commercial |
$11,965.60
|
| Rate for Payer: Cigna of CA HMO |
$8,974.20
|
| Rate for Payer: Cigna of CA PPO |
$8,974.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Dignity Health Media |
$1,772.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,772.43
|
| Rate for Payer: Galaxy Health WC |
$12,713.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,974.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,461.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,217.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,906.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,772.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2,658.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,976.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,991.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,375.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,375.06
|
| Rate for Payer: Multiplan Commercial |
$11,217.75
|
| Rate for Payer: Networks By Design Commercial |
$8,974.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,713.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,878.78
|
| Rate for Payer: Riverside University Health System MISP |
$1,949.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131,711.00
|
| Rate for Payer: United Healthcare All Other HMO |
$94,270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89,754.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82,073.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,772.43
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
OP
|
$11,432.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,519.00 |
| Max. Negotiated Rate |
$96,586.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,772.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,772.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,219.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,367.62
|
| Rate for Payer: Blue Distinction Transplant |
$6,859.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,064.98
|
| Rate for Payer: Blue Shield of California EPN |
$5,555.95
|
| Rate for Payer: Caremore Medicare Advantage |
$1,772.43
|
| Rate for Payer: Cash Price |
$5,144.40
|
| Rate for Payer: Cash Price |
$5,144.40
|
| Rate for Payer: Cash Price |
$5,144.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,145.60
|
| Rate for Payer: Cigna of CA HMO |
$6,859.20
|
| Rate for Payer: Cigna of CA PPO |
$6,859.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Dignity Health Media |
$1,772.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,772.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,772.43
|
| Rate for Payer: Galaxy Health WC |
$9,717.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,859.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,288.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,574.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,906.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,772.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2,658.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,625.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,286.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,375.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,375.06
|
| Rate for Payer: Multiplan Commercial |
$8,574.00
|
| Rate for Payer: Networks By Design Commercial |
$6,859.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,717.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,878.78
|
| Rate for Payer: Riverside University Health System MISP |
$1,949.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$96,586.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69,130.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65,824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60,190.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,658.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,772.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,772.43
|
|
|
HC PROTON SIMPLE W COMPENSATOR
|
Facility
|
IP
|
$11,432.00
|
|
|
Service Code
|
CPT 77522
|
| Hospital Charge Code |
904810910
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$2,286.40 |
| Max. Negotiated Rate |
$10,288.80 |
| Rate for Payer: Cash Price |
$5,144.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,572.80
|
| Rate for Payer: Galaxy Health WC |
$9,717.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,859.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,288.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,625.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,355.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,286.40
|
| Rate for Payer: Multiplan Commercial |
$8,574.00
|
| Rate for Payer: Networks By Design Commercial |
$7,430.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,717.20
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
OP
|
$7,876.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$735.49 |
| Max. Negotiated Rate |
$96,586.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$735.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,519.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,596.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,386.93
|
| Rate for Payer: Blue Distinction Transplant |
$4,725.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,867.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,827.74
|
| Rate for Payer: Caremore Medicare Advantage |
$735.49
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,300.80
|
| Rate for Payer: Cigna of CA HMO |
$4,725.60
|
| Rate for Payer: Cigna of CA PPO |
$4,725.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$735.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$6,694.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,725.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,088.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,907.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: InnovAge PACE Commercial |
$1,103.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,253.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,575.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$985.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$5,907.00
|
| Rate for Payer: Networks By Design Commercial |
$4,725.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,694.60
|
| Rate for Payer: Prime Health Services Medicare |
$779.62
|
| Rate for Payer: Riverside University Health System MISP |
$809.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$96,586.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69,130.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65,824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60,190.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$735.49
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC PROTON SIMPLE WO COMPENSATOR
|
Facility
|
IP
|
$7,876.00
|
|
|
Service Code
|
CPT 77520
|
| Hospital Charge Code |
904810901
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$1,575.20 |
| Max. Negotiated Rate |
$7,088.40 |
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,300.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Galaxy Health WC |
$6,694.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,725.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,088.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,253.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,000.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,575.20
|
| Rate for Payer: Multiplan Commercial |
$5,907.00
|
| Rate for Payer: Networks By Design Commercial |
$5,119.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,694.60
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$189.16 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$380.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$844.84
|
| Rate for Payer: Blue Distinction Transplant |
$858.00
|
| Rate for Payer: Blue Shield of California Commercial |
$883.74
|
| Rate for Payer: Blue Shield of California EPN |
$694.98
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$915.20
|
| Rate for Payer: Cigna of CA PPO |
$1,058.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,072.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
|
|
HC PRQ ASP SPL CRD CYST OR SYRINX
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT 62268
|
| Hospital Charge Code |
909082268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$608.34 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,835.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| Rate for Payer: Cigna of CA PPO |
$2,263.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,753.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,294.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: Networks By Design Commercial |
$1,988.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,835.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC PRQ ASP SPL CRD CYST OR SYRINX
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT 62268
|
| Hospital Charge Code |
909082268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$611.80 |
| Max. Negotiated Rate |
$2,753.10 |
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,753.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: Networks By Design Commercial |
$1,988.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
|
|
HC PRTCTR HEEL HEELMEDIX PETITE
|
Facility
|
IP
|
$250.25
|
|
| Hospital Charge Code |
901606282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$225.22 |
| Rate for Payer: Cash Price |
$112.61
|
| Rate for Payer: Central Health Plan Commercial |
$200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.10
|
| Rate for Payer: Galaxy Health WC |
$212.71
|
| Rate for Payer: Global Benefits Group Commercial |
$150.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.05
|
| Rate for Payer: Multiplan Commercial |
$187.69
|
| Rate for Payer: Networks By Design Commercial |
$162.66
|
| Rate for Payer: Prime Health Services Commercial |
$212.71
|
|
|
HC PRTCTR HEEL HEELMEDIX PETITE
|
Facility
|
OP
|
$250.25
|
|
| Hospital Charge Code |
901606282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$225.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$151.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.85
|
| Rate for Payer: Blue Distinction Transplant |
$150.15
|
| Rate for Payer: Blue Shield of California Commercial |
$157.41
|
| Rate for Payer: Blue Shield of California EPN |
$122.37
|
| Rate for Payer: Cash Price |
$112.61
|
| Rate for Payer: Central Health Plan Commercial |
$200.20
|
| Rate for Payer: Cigna of CA HMO |
$160.16
|
| Rate for Payer: Cigna of CA PPO |
$185.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.71
|
| Rate for Payer: Dignity Health Media |
$212.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.10
|
| Rate for Payer: Galaxy Health WC |
$212.71
|
| Rate for Payer: Global Benefits Group Commercial |
$150.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$187.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.05
|
| Rate for Payer: Multiplan Commercial |
$187.69
|
| Rate for Payer: Networks By Design Commercial |
$162.66
|
| Rate for Payer: Prime Health Services Commercial |
$212.71
|
| Rate for Payer: Riverside University Health System MISP |
$100.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.12
|
| Rate for Payer: United Healthcare All Other HMO |
$125.12
|
| Rate for Payer: United Healthcare HMO Rider |
$125.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.71
|
| Rate for Payer: Vantage Medical Group Senior |
$212.71
|
|
|
HC PRTCTR HEEL HEELMEDIX STRD
|
Facility
|
IP
|
$302.82
|
|
| Hospital Charge Code |
901606281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Central Health Plan Commercial |
$242.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.13
|
| Rate for Payer: Galaxy Health WC |
$257.40
|
| Rate for Payer: Global Benefits Group Commercial |
$181.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.56
|
| Rate for Payer: Multiplan Commercial |
$227.12
|
| Rate for Payer: Networks By Design Commercial |
$196.83
|
| Rate for Payer: Prime Health Services Commercial |
$257.40
|
|
|
HC PRTCTR HEEL HEELMEDIX STRD
|
Facility
|
OP
|
$302.82
|
|
| Hospital Charge Code |
901606281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$183.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.91
|
| Rate for Payer: Blue Distinction Transplant |
$181.69
|
| Rate for Payer: Blue Shield of California Commercial |
$190.47
|
| Rate for Payer: Blue Shield of California EPN |
$148.08
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Central Health Plan Commercial |
$242.26
|
| Rate for Payer: Cigna of CA HMO |
$193.80
|
| Rate for Payer: Cigna of CA PPO |
$224.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.40
|
| Rate for Payer: Dignity Health Media |
$257.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.13
|
| Rate for Payer: Galaxy Health WC |
$257.40
|
| Rate for Payer: Global Benefits Group Commercial |
$181.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$227.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.56
|
| Rate for Payer: Multiplan Commercial |
$227.12
|
| Rate for Payer: Networks By Design Commercial |
$196.83
|
| Rate for Payer: Prime Health Services Commercial |
$257.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.41
|
| Rate for Payer: United Healthcare All Other HMO |
$151.41
|
| Rate for Payer: United Healthcare HMO Rider |
$151.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.40
|
| Rate for Payer: Vantage Medical Group Senior |
$257.40
|
|
