|
HC SOM TCP 88184
|
Facility
|
IP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$179.44 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Central Health Plan Commercial |
$159.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.75
|
| Rate for Payer: EPIC Health Plan Senior |
$79.75
|
| Rate for Payer: Galaxy Health WC |
$169.47
|
| Rate for Payer: Global Benefits Group Commercial |
$119.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.88
|
| Rate for Payer: Multiplan Commercial |
$149.53
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.47
|
|
|
HC SOM TCP 88184
|
Facility
|
OP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$461.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.51
|
| Rate for Payer: Blue Shield of California Commercial |
$125.61
|
| Rate for Payer: Blue Shield of California EPN |
$79.15
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Central Health Plan Commercial |
$159.50
|
| Rate for Payer: Cigna of CA HMO |
$127.60
|
| Rate for Payer: Cigna of CA PPO |
$147.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$169.47
|
| Rate for Payer: Global Benefits Group Commercial |
$119.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$149.53
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$461.02
|
| Rate for Payer: Prime Health Services Commercial |
$169.47
|
| Rate for Payer: Prime Health Services Medicare |
$488.68
|
| Rate for Payer: Riverside University Health System MISP |
$507.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
|
OP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$263.03 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Central Health Plan Commercial |
$7.15
|
| Rate for Payer: Cigna of CA HMO |
$5.72
|
| Rate for Payer: Cigna of CA PPO |
$6.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.03
|
| Rate for Payer: EPIC Health Plan Senior |
$28.02
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.47
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Medicare |
$27.00
|
| Rate for Payer: Riverside University Health System MISP |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.63
|
| Rate for Payer: United Healthcare All Other HMO |
$20.63
|
| Rate for Payer: United Healthcare HMO Rider |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
|
IP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Central Health Plan Commercial |
$7.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Senior |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
|
|
HC SOM TESTOSTERONE TOTAL
|
Facility
|
IP
|
$9.06
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900915375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Central Health Plan Commercial |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: EPIC Health Plan Senior |
$3.62
|
| Rate for Payer: Galaxy Health WC |
$7.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$6.79
|
| Rate for Payer: Networks By Design Commercial |
$5.89
|
| Rate for Payer: Prime Health Services Commercial |
$7.70
|
|
|
HC SOM TESTOSTERONE TOTAL
|
Facility
|
OP
|
$9.06
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900915375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$261.06 |
| Rate for Payer: Adventist Health Commercial |
$1.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.06
|
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Central Health Plan Commercial |
$7.25
|
| Rate for Payer: Cigna of CA HMO |
$5.80
|
| Rate for Payer: Cigna of CA PPO |
$6.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| Rate for Payer: Galaxy Health WC |
$7.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$6.79
|
| Rate for Payer: Networks By Design Commercial |
$5.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.70
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Riverside University Health System MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$151.64 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.64
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.99
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$272.50 |
| Max. Negotiated Rate |
$1,226.25 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,090.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$953.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$545.00
|
| Rate for Payer: EPIC Health Plan Senior |
$545.00
|
| Rate for Payer: Galaxy Health WC |
$1,158.12
|
| Rate for Payer: Global Benefits Group Commercial |
$817.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,226.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$865.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: Networks By Design Commercial |
$885.62
|
| Rate for Payer: Prime Health Services Commercial |
$1,158.12
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.01 |
| Max. Negotiated Rate |
$1,513.57 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,513.57
|
| Rate for Payer: Blue Shield of California Commercial |
$858.38
|
| Rate for Payer: Blue Shield of California EPN |
$540.91
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,090.00
|
| Rate for Payer: Cigna of CA HMO |
$872.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$953.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.58
|
| Rate for Payer: EPIC Health Plan Senior |
$203.72
|
| Rate for Payer: Galaxy Health WC |
$1,158.12
|
| Rate for Payer: Global Benefits Group Commercial |
$817.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,226.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$865.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: Networks By Design Commercial |
$885.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$185.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,158.12
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Riverside University Health System MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$817.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$817.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM THALLIUM URINE
|
Facility
|
IP
|
$36.14
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Central Health Plan Commercial |
$28.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.72
|
| Rate for Payer: Global Benefits Group Commercial |
$21.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.11
|
| Rate for Payer: Networks By Design Commercial |
$23.49
|
| Rate for Payer: Prime Health Services Commercial |
$30.72
|
|
|
HC SOM THALLIUM URINE
|
Facility
|
OP
|
$36.14
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$188.47 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.47
|
| Rate for Payer: Blue Shield of California Commercial |
$22.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.35
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Central Health Plan Commercial |
$28.91
|
| Rate for Payer: Cigna of CA HMO |
$23.13
|
| Rate for Payer: Cigna of CA PPO |
$26.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.23
|
| Rate for Payer: EPIC Health Plan Senior |
$24.16
|
| Rate for Payer: Galaxy Health WC |
$30.72
|
| Rate for Payer: Global Benefits Group Commercial |
$21.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$27.11
|
| Rate for Payer: Networks By Design Commercial |
$23.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.96
|
| Rate for Payer: Prime Health Services Commercial |
$30.72
|
| Rate for Payer: Prime Health Services Medicare |
$23.28
|
| Rate for Payer: Riverside University Health System MISP |
$24.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.78
|
| Rate for Payer: United Healthcare All Other HMO |
$17.78
|
| Rate for Payer: United Healthcare HMO Rider |
$17.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
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: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Central Health Plan Commercial |
$25.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| 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 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 |
$229.80 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| 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 |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.91
|
| Rate for Payer: Blue Shield of California EPN |
$12.55
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$31.60
|
| 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 Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.12
|
| 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 Commercial/Exchange |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
|
HC SOM THIOPURINE METAB
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC SOM THIOPURINE METAB
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| 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 |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| 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 |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| 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 THYROBLUBULIN AB
|
Facility
|
OP
|
$10.57
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$160.83 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| 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 |
$160.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.20
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Central Health Plan Commercial |
$8.46
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$7.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.50
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| 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 |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| 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: Upland Medical Group Pediatric |
$15.91
|
| 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 THYROBLUBULIN AB
|
Facility
|
IP
|
$10.57
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Central Health Plan Commercial |
$8.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.23
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.87
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
|
|
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 |
$160.83 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| 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 |
$160.83
|
| Rate for Payer: Blue Shield of California Commercial |
$14.35
|
| Rate for Payer: Blue Shield of California EPN |
$9.04
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$22.78
|
| 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 Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.50
|
| 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: Heritage Provider Network Commercial/Senior |
$26.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| Rate for Payer: Networks By Design Commercial |
$14.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.91
|
| 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: Upland Medical Group Pediatric |
$15.91
|
| 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: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Central Health Plan Commercial |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.95
|
| 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: Global Benefits Group Commercial |
$13.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| 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
|
OP
|
$9.09
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$160.83 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| 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 |
$160.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Central Health Plan Commercial |
$7.27
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.25
|
| Rate for Payer: EPIC Health Plan Senior |
$17.50
|
| Rate for Payer: Galaxy Health WC |
$7.73
|
| Rate for Payer: Global Benefits Group Commercial |
$5.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$7.73
|
| 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 |
$5.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.45
|
| 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: Upland Medical Group Pediatric |
$15.91
|
| 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 AB
|
Facility
|
IP
|
$9.09
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.18 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Central Health Plan Commercial |
$7.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.73
|
| Rate for Payer: Global Benefits Group Commercial |
$5.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.91
|
| Rate for Payer: Prime Health Services Commercial |
$7.73
|
|
|
HC SOM THYROGLOBULIN TUMOR MARKER TM
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900912645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$165.66 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| 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 |
$165.66
|
| Rate for Payer: Blue Shield of California Commercial |
$5.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.64
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.34
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.50
|
| Rate for Payer: EPIC Health Plan Senior |
$17.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.06
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
| 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 |
$5.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.51
|
| 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
|
$9.18
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900912645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Central Health Plan Commercial |
$7.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
|
|
HC SOM THYROID BINDING GLOBULIN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
