|
HC SOM THYROGLOBULIN TM THYRO AB
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$19.36 |
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.11
|
| Rate for Payer: EPIC Health Plan Senior |
$9.11
|
| Rate for Payer: Galaxy Health WC |
$19.36
|
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$18.22
|
| Rate for Payer: Networks By Design Commercial |
$14.81
|
| Rate for Payer: Prime Health Services Commercial |
$19.36
|
|
|
HC SOM THYROGLOBULIN TUMOR MARKER TM
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900912645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$161.79 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.79
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.51
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.68
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Vantage Medical Group Senior |
$16.06
|
|
|
HC SOM THYROGLOBULIN TUMOR MARKER TM
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900912645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
HC SOM THYROID BINDING GLOBULIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.95
|
| Rate for Payer: EPIC Health Plan Senior |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM THYROID BINDING GLOBULIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM THYROPEROXIDASE AB
|
Facility
|
IP
|
$11.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$10.12
|
| Rate for Payer: Global Benefits Group Commercial |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$10.12
|
|
|
HC SOM THYROPEROXIDASE AB
|
Facility
|
OP
|
$11.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$144.63 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$8.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.64
|
| Rate for Payer: EPIC Health Plan Senior |
$14.55
|
| Rate for Payer: Galaxy Health WC |
$10.12
|
| Rate for Payer: Global Benefits Group Commercial |
$7.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$10.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.79
|
| Rate for Payer: United Healthcare All Other HMO |
$11.79
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.55
|
|
|
HC SOM THYROTROPIN RECEPTOR
|
Facility
|
IP
|
$17.27
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$14.68 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$6.91
|
| Rate for Payer: Galaxy Health WC |
$14.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$14.68
|
|
|
HC SOM THYROTROPIN RECEPTOR
|
Facility
|
OP
|
$17.27
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$7.63
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$12.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$14.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$13.82
|
| Rate for Payer: Networks By Design Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$14.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM THYROXINE (T4), FREE
|
Facility
|
IP
|
$63.10
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$53.63 |
| Rate for Payer: Adventist Health Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.24
|
| Rate for Payer: EPIC Health Plan Senior |
$25.24
|
| Rate for Payer: Galaxy Health WC |
$53.63
|
| Rate for Payer: Global Benefits Group Commercial |
$37.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$50.48
|
| Rate for Payer: Networks By Design Commercial |
$41.02
|
| Rate for Payer: Prime Health Services Commercial |
$53.63
|
|
|
HC SOM THYROXINE (T4), FREE
|
Facility
|
OP
|
$63.10
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$89.04 |
| Rate for Payer: Adventist Health Commercial |
$12.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.04
|
| Rate for Payer: Blue Shield of California Commercial |
$42.21
|
| Rate for Payer: Blue Shield of California EPN |
$27.89
|
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: Cigna of CA HMO |
$40.38
|
| Rate for Payer: Cigna of CA PPO |
$46.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$53.63
|
| Rate for Payer: Global Benefits Group Commercial |
$37.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$50.48
|
| Rate for Payer: Networks By Design Commercial |
$41.02
|
| Rate for Payer: Prime Health Services Commercial |
$53.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC SOM THYROXIN TOTAL
|
Facility
|
IP
|
$9.84
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900912522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Multiplan Commercial |
$7.87
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
|
|
HC SOM THYROXIN TOTAL
|
Facility
|
OP
|
$9.84
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900912522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.35
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$7.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.27
|
| Rate for Payer: EPIC Health Plan Senior |
$6.87
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$7.87
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO |
$5.56
|
| Rate for Payer: United Healthcare HMO Rider |
$5.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
|
|
HC SOM TIAGABINE LEVEL
|
Facility
|
IP
|
$88.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$75.36 |
| Rate for Payer: Adventist Health Commercial |
$17.73
|
| Rate for Payer: Cash Price |
$88.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.46
|
| Rate for Payer: EPIC Health Plan Senior |
$35.46
|
| Rate for Payer: Galaxy Health WC |
$75.36
|
| Rate for Payer: Global Benefits Group Commercial |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$70.93
|
| Rate for Payer: Networks By Design Commercial |
$57.63
|
| Rate for Payer: Prime Health Services Commercial |
$75.36
|
|
|
HC SOM TIAGABINE LEVEL
|
Facility
|
OP
|
$88.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Adventist Health Commercial |
$17.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.26
|
| Rate for Payer: Blue Shield of California Commercial |
$59.31
|
| Rate for Payer: Blue Shield of California EPN |
$39.19
|
| Rate for Payer: Cash Price |
$88.66
|
| Rate for Payer: Cash Price |
$88.66
|
| Rate for Payer: Cigna of CA HMO |
$56.74
|
| Rate for Payer: Cigna of CA PPO |
$65.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$75.36
|
| Rate for Payer: Global Benefits Group Commercial |
$53.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$70.93
|
| Rate for Payer: Networks By Design Commercial |
$57.63
|
| Rate for Payer: Prime Health Services Commercial |
$75.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM TISSUE CULTURE NEOPLASTIC
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$217.43
|
| Rate for Payer: Blue Shield of California EPN |
$143.65
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$260.00
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC SOM TISSUE CULTURE NEOPLASTIC
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$260.00
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
|
HC SOM TISSUE TRANSGLT AB IGA
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.67
|
| 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 HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.87
|
| Rate for Payer: Blue Shield of California EPN |
$6.52
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna of CA HMO |
$9.44
|
| Rate for Payer: Cigna of CA PPO |
$10.91
|
| 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: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$11.80
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.85
|
| 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 TISSUE TRANSGLT AB IGA
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$11.80
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
|
|
HC SOM TMP 80299
|
Facility
|
IP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$16.67 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$7.84
|
| Rate for Payer: Galaxy Health WC |
$16.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.71
|
| Rate for Payer: Multiplan Commercial |
$15.69
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$16.67
|
|
|
HC SOM TMP 80299
|
Facility
|
OP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.67
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cigna of CA HMO |
$12.55
|
| Rate for Payer: Cigna of CA PPO |
$14.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$16.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$15.69
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$16.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM TOPIRAMATE
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
900910764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$146.29 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna of CA HMO |
$11.20
|
| Rate for Payer: Cigna of CA PPO |
$12.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.09
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$14.00
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.66
|
| Rate for Payer: United Healthcare HMO Rider |
$9.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$11.92
|
|
|
HC SOM TOPIRAMATE
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
900910764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.88 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.00
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
|
|
HC SOMTOX 20323 DRUG SCRN 11
|
Facility
|
IP
|
$155.03
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900914758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$131.78 |
| Rate for Payer: Adventist Health Commercial |
$31.01
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.01
|
| Rate for Payer: EPIC Health Plan Senior |
$62.01
|
| Rate for Payer: Galaxy Health WC |
$131.78
|
| Rate for Payer: Global Benefits Group Commercial |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.21
|
| Rate for Payer: Multiplan Commercial |
$124.02
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$131.78
|
|
|
HC SOMTOX 20323 DRUG SCRN 11
|
Facility
|
OP
|
$155.03
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900914758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Adventist Health Commercial |
$31.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.65
|
| Rate for Payer: Blue Shield of California Commercial |
$103.72
|
| Rate for Payer: Blue Shield of California EPN |
$68.52
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cash Price |
$85.27
|
| Rate for Payer: Cigna of CA HMO |
$99.22
|
| Rate for Payer: Cigna of CA PPO |
$114.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$131.78
|
| Rate for Payer: Global Benefits Group Commercial |
$93.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$124.02
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$131.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
