|
HC SOM THC CONFIRMATION, U
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$201.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.62
|
| Rate for Payer: Blue Distinction Transplant |
$18.96
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Central Health Plan Commercial |
$25.28
|
| Rate for Payer: Cigna of CA HMO |
$20.22
|
| Rate for Payer: Cigna of CA PPO |
$23.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Media |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$20.54
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
| Rate for Payer: Riverside University Health System MISP |
$12.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.80
|
| Rate for Payer: United Healthcare All Other HMO |
$15.80
|
| Rate for Payer: United Healthcare HMO Rider |
$15.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Central Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$20.54
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
|
|
HC SOM THIOPURINE METAB
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC SOM THIOPURINE METAB
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| 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 Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.22
|
| Rate for Payer: Blue Distinction Transplant |
$106.80
|
| Rate for Payer: Blue Shield of California Commercial |
$110.00
|
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$133.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| 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 |
$35.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| 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: 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 THYROBLUBULIN AB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM THYROBLUBULIN AB
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$141.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.11
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Media |
$15.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: InnovAge PACE Commercial |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.86
|
| Rate for Payer: Riverside University Health System MISP |
$17.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.89
|
| Rate for Payer: United Healthcare All Other HMO |
$12.89
|
| Rate for Payer: United Healthcare HMO Rider |
$12.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.91
|
|
|
HC SOM THYROGLOBULIN TM THYRO AB
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$141.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.11
|
| Rate for Payer: Blue Distinction Transplant |
$13.67
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$11.07
|
| Rate for Payer: Caremore Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Central Health Plan Commercial |
$18.22
|
| Rate for Payer: Cigna of CA HMO |
$14.58
|
| Rate for Payer: Cigna of CA PPO |
$16.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Media |
$15.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$19.36
|
| Rate for Payer: Global Benefits Group Commercial |
$13.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: InnovAge PACE Commercial |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$17.08
|
| Rate for Payer: Networks By Design Commercial |
$14.81
|
| Rate for Payer: Prime Health Services Commercial |
$19.36
|
| Rate for Payer: Prime Health Services Medicare |
$16.86
|
| Rate for Payer: Riverside University Health System MISP |
$17.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.89
|
| Rate for Payer: United Healthcare All Other HMO |
$12.89
|
| Rate for Payer: United Healthcare HMO Rider |
$12.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.91
|
|
|
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 |
$20.50 |
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Central Health Plan Commercial |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.11
|
| Rate for Payer: Galaxy Health WC |
$19.36
|
| Rate for Payer: Global Benefits Group Commercial |
$13.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.50
|
| 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: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$17.08
|
| Rate for Payer: Networks By Design Commercial |
$14.81
|
| Rate for Payer: Prime Health Services Commercial |
$19.36
|
|
|
HC SOM THYROGLOBULIN TUMOR MARKER AB
|
Facility
|
IP
|
$10.10
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.58
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
|
|
HC SOM THYROGLOBULIN TUMOR MARKER AB
|
Facility
|
OP
|
$10.10
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$141.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.11
|
| Rate for Payer: Blue Distinction Transplant |
$6.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Caremore Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$8.08
|
| Rate for Payer: Cigna of CA HMO |
$6.46
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Media |
$15.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: InnovAge PACE Commercial |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$7.58
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Medicare |
$16.86
|
| Rate for Payer: Riverside University Health System MISP |
$17.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.89
|
| Rate for Payer: United Healthcare All Other HMO |
$12.89
|
| Rate for Payer: United Healthcare HMO Rider |
$12.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.91
|
|
|
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 |
$145.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| 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 Exchange |
$119.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.35
|
| Rate for Payer: Blue Distinction Transplant |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Caremore Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| 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 Media |
$16.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: InnovAge PACE Commercial |
$24.09
|
| 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 |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Prime Health Services Medicare |
$17.02
|
| Rate for Payer: Riverside University Health System MISP |
$17.67
|
| 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 |
$13.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.00
|
| 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 |
$9.18 |
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Central Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.18
|
| 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: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
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 |
$18.00 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| 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: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
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 |
$122.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.60
|
| 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 Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.59
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| 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 Media |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.78
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: InnovAge PACE Commercial |
$22.17
|
| 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 |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$15.67
|
| Rate for Payer: Riverside University Health System MISP |
$16.26
|
| 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: 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 STIMULATING IG
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
900915372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC SOM THYROID STIMULATING IG
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
900915372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$373.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$292.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.35
|
| Rate for Payer: Blue Distinction Transplant |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California EPN |
$20.90
|
| Rate for Payer: Caremore Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.29
|
| Rate for Payer: Dignity Health Media |
$50.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.86
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.86
|
| Rate for Payer: InnovAge PACE Commercial |
$76.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$53.91
|
| Rate for Payer: Riverside University Health System MISP |
$55.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.19
|
| Rate for Payer: United Healthcare All Other HMO |
$41.19
|
| Rate for Payer: United Healthcare HMO Rider |
$41.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.86
|
|
|
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 |
$10.71 |
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Central Health Plan Commercial |
$9.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$10.12
|
| Rate for Payer: Global Benefits Group Commercial |
$7.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.71
|
| 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: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
| 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 |
$129.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.82
|
| 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 Exchange |
$106.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.93
|
| Rate for Payer: Blue Distinction Transplant |
$7.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7.35
|
| Rate for Payer: Blue Shield of California EPN |
$5.78
|
| Rate for Payer: Caremore Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Central Health Plan Commercial |
$9.52
|
| 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 Media |
$14.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.55
|
| Rate for Payer: Galaxy Health WC |
$10.12
|
| Rate for Payer: Global Benefits Group Commercial |
$7.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: InnovAge PACE Commercial |
$21.82
|
| 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 |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
| Rate for Payer: Networks By Design Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$10.12
|
| Rate for Payer: Prime Health Services Medicare |
$15.42
|
| Rate for Payer: Riverside University Health System MISP |
$16.00
|
| 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: 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 |
$15.54 |
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Central Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: Galaxy Health WC |
$14.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.54
|
| 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: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| 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 |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| 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 Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: Blue Distinction Transplant |
$10.36
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Central Health Plan Commercial |
$13.82
|
| 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 |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$14.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.90
|
| 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 |
$3.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| Rate for Payer: Networks By Design Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$14.68
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.90
|
| 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
|
OP
|
$121.28
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$109.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.20
|
| 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 Exchange |
$65.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.99
|
| Rate for Payer: Blue Distinction Transplant |
$72.77
|
| Rate for Payer: Blue Shield of California Commercial |
$74.95
|
| Rate for Payer: Blue Shield of California EPN |
$58.94
|
| Rate for Payer: Caremore Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$54.58
|
| Rate for Payer: Cash Price |
$54.58
|
| Rate for Payer: Central Health Plan Commercial |
$97.02
|
| Rate for Payer: Cigna of CA HMO |
$77.62
|
| Rate for Payer: Cigna of CA PPO |
$89.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Media |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$103.09
|
| Rate for Payer: Global Benefits Group Commercial |
$72.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: InnovAge PACE Commercial |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.89
|
| 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 |
$24.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$90.96
|
| Rate for Payer: Networks By Design Commercial |
$78.83
|
| Rate for Payer: Prime Health Services Commercial |
$103.09
|
| Rate for Payer: Prime Health Services Medicare |
$9.56
|
| Rate for Payer: Riverside University Health System MISP |
$9.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.77
|
| 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: 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 THYROXINE (T4), FREE
|
Facility
|
IP
|
$121.28
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$109.15 |
| Rate for Payer: Cash Price |
$54.58
|
| Rate for Payer: Central Health Plan Commercial |
$97.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.51
|
| Rate for Payer: Galaxy Health WC |
$103.09
|
| Rate for Payer: Global Benefits Group Commercial |
$72.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.26
|
| Rate for Payer: Multiplan Commercial |
$90.96
|
| Rate for Payer: Networks By Design Commercial |
$78.83
|
| Rate for Payer: Prime Health Services Commercial |
$103.09
|
|
|
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 |
$60.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.44
|
| 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 Exchange |
$50.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.99
|
| Rate for Payer: Blue Distinction Transplant |
$5.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Caremore Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| 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 Media |
$6.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.87
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: InnovAge PACE Commercial |
$10.30
|
| 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 |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Medicare |
$7.28
|
| Rate for Payer: Riverside University Health System MISP |
$7.56
|
| 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: 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 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 |
$8.86 |
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| 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: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
|
|
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 |
$292.50 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
