|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
IP
|
$18.74
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Central Health Plan Commercial |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$15.93
|
| Rate for Payer: Global Benefits Group Commercial |
$11.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$14.05
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.93
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
OP
|
$18.74
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$167.91 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.91
|
| Rate for Payer: Blue Shield of California Commercial |
$11.81
|
| Rate for Payer: Blue Shield of California EPN |
$7.44
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Central Health Plan Commercial |
$14.99
|
| Rate for Payer: Cigna of CA HMO |
$11.99
|
| Rate for Payer: Cigna of CA PPO |
$13.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.25
|
| Rate for Payer: Galaxy Health WC |
$15.93
|
| Rate for Payer: Global Benefits Group Commercial |
$11.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$14.05
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.59
|
| Rate for Payer: Prime Health Services Commercial |
$15.93
|
| Rate for Payer: Prime Health Services Medicare |
$17.59
|
| Rate for Payer: Riverside University Health System MISP |
$18.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO |
$13.44
|
| Rate for Payer: United Healthcare HMO Rider |
$13.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Vantage Medical Group Senior |
$16.59
|
|
|
HC SOM PROBE SET COUNT
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,715.87 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.87
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM PROBE SET COUNT
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900915278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM PROINSULIN
|
Facility
|
IP
|
$51.45
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$46.30 |
| Rate for Payer: Adventist Health Commercial |
$10.29
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Central Health Plan Commercial |
$41.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.58
|
| Rate for Payer: EPIC Health Plan Senior |
$20.58
|
| Rate for Payer: Galaxy Health WC |
$43.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$38.59
|
| Rate for Payer: Networks By Design Commercial |
$33.44
|
| Rate for Payer: Prime Health Services Commercial |
$43.73
|
|
|
HC SOM PROINSULIN
|
Facility
|
OP
|
$51.45
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
900911398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$174.31 |
| Rate for Payer: Adventist Health Commercial |
$10.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.31
|
| Rate for Payer: Blue Shield of California Commercial |
$32.41
|
| Rate for Payer: Blue Shield of California EPN |
$20.43
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Central Health Plan Commercial |
$41.16
|
| Rate for Payer: Cigna of CA HMO |
$32.93
|
| Rate for Payer: Cigna of CA PPO |
$38.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.04
|
| Rate for Payer: EPIC Health Plan Senior |
$29.36
|
| Rate for Payer: Galaxy Health WC |
$43.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$38.59
|
| Rate for Payer: Networks By Design Commercial |
$33.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.69
|
| Rate for Payer: Prime Health Services Commercial |
$43.73
|
| Rate for Payer: Prime Health Services Medicare |
$28.29
|
| Rate for Payer: Riverside University Health System MISP |
$29.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.62
|
| Rate for Payer: United Healthcare All Other HMO |
$21.62
|
| Rate for Payer: United Healthcare HMO Rider |
$21.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Vantage Medical Group Senior |
$26.69
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
OP
|
$13.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$186.02 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.02
|
| Rate for Payer: Blue Shield of California Commercial |
$8.62
|
| Rate for Payer: Blue Shield of California EPN |
$5.43
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.94
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PROSTATE HEALTH INDEX
|
Facility
|
IP
|
$13.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900915518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
| Rate for Payer: EPIC Health Plan Senior |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$11.63
|
| Rate for Payer: Global Benefits Group Commercial |
$8.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$11.63
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM PROTEINASE 3 AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
IP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$201.22 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Central Health Plan Commercial |
$178.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.43
|
| Rate for Payer: EPIC Health Plan Senior |
$89.43
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.72
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
|
|
HC SOM PROTEIN C AG
|
Facility
|
OP
|
$223.58
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
900913801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$201.22 |
| Rate for Payer: Adventist Health Commercial |
$44.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$140.86
|
| Rate for Payer: Blue Shield of California EPN |
$88.76
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Cash Price |
$223.58
|
| Rate for Payer: Central Health Plan Commercial |
$178.86
|
| Rate for Payer: Cigna of CA HMO |
$143.09
|
| Rate for Payer: Cigna of CA PPO |
$165.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.82
|
| Rate for Payer: EPIC Health Plan Senior |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$190.04
|
| Rate for Payer: Global Benefits Group Commercial |
$134.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.09
|
| Rate for Payer: Multiplan Commercial |
$167.69
|
| Rate for Payer: Networks By Design Commercial |
$145.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.01
|
| Rate for Payer: Prime Health Services Commercial |
$190.04
|
| Rate for Payer: Prime Health Services Medicare |
$12.73
|
| Rate for Payer: Riverside University Health System MISP |
$13.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.73
|
| Rate for Payer: United Healthcare All Other HMO |
$9.73
|
| Rate for Payer: United Healthcare HMO Rider |
$9.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.01
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
OP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$176.69 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.69
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Central Health Plan Commercial |
$19.90
|
| Rate for Payer: Cigna of CA HMO |
$15.92
|
| Rate for Payer: Cigna of CA PPO |
$18.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Senior |
$19.61
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
| Rate for Payer: Networks By Design Commercial |
$16.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.83
|
| Rate for Payer: Prime Health Services Commercial |
$21.15
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM PROTEIN ELECT URINE
|
Facility
|
IP
|
$24.88
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Central Health Plan Commercial |
$19.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.95
|
| Rate for Payer: EPIC Health Plan Senior |
$9.95
|
| Rate for Payer: Galaxy Health WC |
$21.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$18.66
|
| Rate for Payer: Networks By Design Commercial |
$16.17
|
| Rate for Payer: Prime Health Services Commercial |
$21.15
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Central Health Plan Commercial |
$20.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.18
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$21.63
|
| Rate for Payer: Global Benefits Group Commercial |
$15.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$19.09
|
| Rate for Payer: Networks By Design Commercial |
$16.54
|
| Rate for Payer: Prime Health Services Commercial |
$21.63
|
|
|
HC SOM PROTEIN S AG
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900913807
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$155.04 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.04
|
| Rate for Payer: Blue Shield of California Commercial |
$16.03
|
| Rate for Payer: Blue Shield of California EPN |
$10.10
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Central Health Plan Commercial |
$20.36
|
| Rate for Payer: Cigna of CA HMO |
$16.29
|
| Rate for Payer: Cigna of CA PPO |
$18.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$21.63
|
| Rate for Payer: Global Benefits Group Commercial |
$15.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$19.09
|
| Rate for Payer: Networks By Design Commercial |
$16.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.32
|
| Rate for Payer: Prime Health Services Commercial |
$21.63
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM PROTEIN S PLASMA
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900911277
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$155.04 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.32
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Senior |
$1.65
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
|
|
HC SOM PROTEIN, TOTAL, RANDOM, U
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$37.18 |
| Rate for Payer: Adventist Health Commercial |
$0.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$37.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$2.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
HC SOM PROTEIN TOTAL URINE
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$37.18 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$37.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.28
|
| Rate for Payer: Cigna of CA PPO |
$3.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
OP
|
$126.77
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$25.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$79.87
|
| Rate for Payer: Blue Shield of California EPN |
$50.33
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Central Health Plan Commercial |
$101.42
|
| Rate for Payer: Cigna of CA HMO |
$81.13
|
| Rate for Payer: Cigna of CA PPO |
$93.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$107.75
|
| Rate for Payer: Global Benefits Group Commercial |
$76.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$95.08
|
| Rate for Payer: Networks By Design Commercial |
$82.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$107.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$126.77
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$114.09 |
| Rate for Payer: Adventist Health Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Central Health Plan Commercial |
$101.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.71
|
| Rate for Payer: EPIC Health Plan Senior |
$50.71
|
| Rate for Payer: Galaxy Health WC |
$107.75
|
| Rate for Payer: Global Benefits Group Commercial |
$76.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.35
|
| Rate for Payer: Multiplan Commercial |
$95.08
|
| Rate for Payer: Networks By Design Commercial |
$82.40
|
| Rate for Payer: Prime Health Services Commercial |
$107.75
|
|
