|
HC SOM THYROBLUBULIN AB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
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 |
$4.12 |
| Max. Negotiated Rate |
$145.18 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.65
|
| 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 HMO/PPO |
$145.18
|
| Rate for Payer: Blue Shield of California Commercial |
$127.99
|
| Rate for Payer: Blue Shield of California EPN |
$102.66
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Heritage Provider Network Senior |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.18
|
| 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 |
$4.12 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.42
|
| Rate for Payer: Heritage Provider Network Senior |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Multiplan Commercial |
$17.09
|
|
|
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 |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
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 |
$1.85 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.54
|
| Rate for Payer: Blue Shield of California Commercial |
$129.25
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Senior |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.06
|
| Rate for Payer: TriValley Medical Group Senior |
$16.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.34
|
| 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 THYROID BINDING GLOBULIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$126.12 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$119.00
|
| Rate for Payer: Blue Shield of California EPN |
$95.45
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Senior |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.78
|
| Rate for Payer: TriValley Medical Group Senior |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM THYROID BINDING GLOBULIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM THYROPEROXIDASE AB
|
Facility
|
IP
|
$11.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.93
|
|
|
HC SOM THYROPEROXIDASE AB
|
Facility
|
OP
|
$11.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$133.68 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.68
|
| Rate for Payer: Blue Shield of California Commercial |
$117.10
|
| Rate for Payer: Blue Shield of California EPN |
$93.92
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: Dignity Health Senior |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.37
|
| Rate for Payer: Heritage Provider Network Senior |
$7.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$8.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.55
|
| Rate for Payer: TriValley Medical Group Senior |
$14.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.72
|
| 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
|
OP
|
$17.27
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Senior |
$10.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM THYROTROPIN RECEPTOR
|
Facility
|
IP
|
$17.27
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.69
|
| Rate for Payer: Heritage Provider Network Senior |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
|
|
HC SOM THYROXINE (T4), FREE
|
Facility
|
OP
|
$63.10
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$82.30 |
| Rate for Payer: Adventist Health Commercial |
$12.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.30
|
| Rate for Payer: Blue Shield of California Commercial |
$72.58
|
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Senior |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.06
|
| Rate for Payer: Heritage Provider Network Senior |
$39.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.37
|
| Rate for Payer: Multiplan Commercial |
$47.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.02
|
| Rate for Payer: TriValley Medical Group Senior |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.74
|
| 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
|
$63.10
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$47.33 |
| Rate for Payer: Adventist Health Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.72
|
| Rate for Payer: Heritage Provider Network Senior |
$42.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.78
|
| Rate for Payer: Multiplan Commercial |
$47.33
|
|
|
HC SOM THYROXIN TOTAL
|
Facility
|
IP
|
$9.84
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900912522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.66
|
| Rate for Payer: Heritage Provider Network Senior |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
|
|
HC SOM THYROXIN TOTAL
|
Facility
|
OP
|
$9.84
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900912522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$62.75 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.75
|
| Rate for Payer: Blue Shield of California Commercial |
$55.35
|
| Rate for Payer: Blue Shield of California EPN |
$44.40
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Senior |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.66
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.87
|
| Rate for Payer: TriValley Medical Group Senior |
$6.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
|
|
HC SOM TIAGABINE LEVEL
|
Facility
|
OP
|
$88.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$141.87 |
| Rate for Payer: Adventist Health Commercial |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.14
|
| Rate for Payer: Blue Shield of California Commercial |
$141.87
|
| Rate for Payer: Blue Shield of California EPN |
$113.79
|
| Rate for Payer: Cash Price |
$88.66
|
| Rate for Payer: Cash Price |
$88.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.88
|
| Rate for Payer: Heritage Provider Network Senior |
$54.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$66.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM TIAGABINE LEVEL
|
Facility
|
IP
|
$88.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Adventist Health Commercial |
$17.73
|
| Rate for Payer: Cash Price |
$88.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.02
|
| Rate for Payer: Heritage Provider Network Senior |
$60.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$66.50
|
|
|
HC SOM TISSUE CULTURE NEOPLASTIC
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.03
|
| Rate for Payer: Heritage Provider Network Senior |
$220.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
|
|
HC SOM TISSUE CULTURE NEOPLASTIC
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Senior |
$276.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.18
|
| Rate for Payer: Heritage Provider Network Senior |
$201.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC SOM TISSUE TRANSGLT AB IGA
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Heritage Provider Network Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM TISSUE TRANSGLT AB IGA
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.99
|
| Rate for Payer: Heritage Provider Network Senior |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
|
|
HC SOM TMP 80299
|
Facility
|
IP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$14.71 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$14.71
|
|
|
HC SOM TMP 80299
|
Facility
|
OP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$14.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM TOPIRAMATE
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
900910764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.85
|
| Rate for Payer: Heritage Provider Network Senior |
$11.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
|
|
HC SOM TOPIRAMATE
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
900910764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$135.22 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.22
|
| Rate for Payer: Blue Shield of California Commercial |
$95.96
|
| Rate for Payer: Blue Shield of California EPN |
$76.97
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Senior |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.02
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.92
|
| Rate for Payer: TriValley Medical Group Senior |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$11.92
|
|
