|
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: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Cash Price |
$4.59
|
| 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 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 |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$115.49
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| 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: Humana Medicare |
$14.78
|
| Rate for Payer: IEHP Medi-Cal |
$20.50
|
| Rate for Payer: IEHP Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.44
|
| 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: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 |
$8.92 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: Cash Price |
$5.36
|
| 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 |
$8.92
|
|
|
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 |
$122.56 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.56
|
| Rate for Payer: Blue Shield of California Commercial |
$113.64
|
| Rate for Payer: Blue Shield of California EPN |
$88.84
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cash Price |
$5.36
|
| 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: Humana Medicare |
$14.55
|
| Rate for Payer: IEHP Medi-Cal |
$20.17
|
| Rate for Payer: IEHP Medicare Advantage |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.17
|
| 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 |
$8.92
|
| 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
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: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: Cash Price |
$7.77
|
| 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 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 |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| 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: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| 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 |
$25.90
|
| 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 |
$9.02 |
| Max. Negotiated Rate |
$90.96 |
| Rate for Payer: Adventist Health Commercial |
$24.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.45
|
| Rate for Payer: Blue Shield of California Commercial |
$70.43
|
| Rate for Payer: Blue Shield of California EPN |
$55.06
|
| Rate for Payer: Cash Price |
$54.58
|
| Rate for Payer: Cash Price |
$54.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.83
|
| 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 |
$78.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.07
|
| Rate for Payer: Heritage Provider Network Senior |
$75.07
|
| Rate for Payer: Humana Medicare |
$9.02
|
| Rate for Payer: IEHP Medi-Cal |
$12.34
|
| Rate for Payer: IEHP Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.32
|
| 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 |
$90.96
|
| 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
|
$121.28
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$90.96 |
| Rate for Payer: Adventist Health Commercial |
$24.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.32
|
| Rate for Payer: Cash Price |
$54.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.11
|
| Rate for Payer: Heritage Provider Network Senior |
$82.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.32
|
| Rate for Payer: Multiplan Commercial |
$90.96
|
|
|
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: Aetna of CA Non-Gatekeeper |
$6.76
|
| Rate for Payer: Cash Price |
$4.43
|
| 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 |
$57.53 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.53
|
| Rate for Payer: Blue Shield of California Commercial |
$53.72
|
| Rate for Payer: Blue Shield of California EPN |
$42.00
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| 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: Humana Medicare |
$6.87
|
| Rate for Payer: IEHP Medi-Cal |
$8.08
|
| Rate for Payer: IEHP Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.11
|
| 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 TISSUE CULTURE NEOPLASTIC
|
Facility
OP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$201.82
|
| Rate for Payer: Blue Shield of California EPN |
$190.78
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| 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: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| 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 Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC SOM TISSUE CULTURE NEOPLASTIC
|
Facility
IP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.02
|
| Rate for Payer: Heritage Provider Network Senior |
$220.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
|
|
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: Aetna of CA Non-Gatekeeper |
$10.13
|
| Rate for Payer: Cash Price |
$6.64
|
| 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 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 |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$6.64
|
| 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: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| 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 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 |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$8.82
|
| 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: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| 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 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: Aetna of CA Non-Gatekeeper |
$13.47
|
| Rate for Payer: Cash Price |
$8.82
|
| 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 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: Aetna of CA Non-Gatekeeper |
$12.02
|
| Rate for Payer: Cash Price |
$7.88
|
| 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 |
$123.97 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.97
|
| Rate for Payer: Blue Shield of California Commercial |
$93.13
|
| Rate for Payer: Blue Shield of California EPN |
$72.80
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| 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: Humana Medicare |
$11.92
|
| Rate for Payer: IEHP Medi-Cal |
$16.52
|
| Rate for Payer: IEHP Medicare Advantage |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.07
|
| 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
|
|
|
HC SOMTOX 20323 DRUG SCRN 11
|
Facility
OP
|
$155.03
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900914758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$31.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$69.76
|
| Rate for Payer: Cash Price |
$69.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.96
|
| Rate for Payer: Heritage Provider Network Senior |
$95.96
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: IEHP Medi-Cal |
$67.86
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$116.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOMTOX 20323 DRUG SCRN 11
|
Facility
IP
|
$155.03
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900914758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$116.27 |
| Rate for Payer: Adventist Health Commercial |
$31.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.51
|
| Rate for Payer: Cash Price |
$69.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.96
|
| Rate for Payer: Heritage Provider Network Senior |
$104.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.76
|
| Rate for Payer: Multiplan Commercial |
$116.27
|
|
|
HC SOM TOXOCARA AB
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911594
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM TOXOCARA AB
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911594
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.88
|
| Rate for Payer: Blue Shield of California Commercial |
$101.57
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Humana Medicare |
$13.01
|
| Rate for Payer: IEHP Medi-Cal |
$18.03
|
| Rate for Payer: IEHP Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
OP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$112.41
|
| Rate for Payer: Blue Shield of California EPN |
$87.88
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.08
|
| Rate for Payer: Heritage Provider Network Senior |
$54.08
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: IEHP Medi-Cal |
$19.95
|
| Rate for Payer: IEHP Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
IP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.02
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.14
|
| Rate for Payer: Heritage Provider Network Senior |
$59.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
|
