|
HC SOM TCP 86361
|
Facility
|
OP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$255.69 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.69
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.68
|
| Rate for Payer: Heritage Provider Network Senior |
$50.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.78
|
| Rate for Payer: TriValley Medical Group Senior |
$26.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC SOM TCP 86361
|
Facility
|
IP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.72
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.43
|
| Rate for Payer: Heritage Provider Network Senior |
$55.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
|
|
HC SOM TCP 88184
|
Facility
|
IP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$149.53 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.40
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.98
|
| Rate for Payer: Heritage Provider Network Senior |
$134.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.84
|
| Rate for Payer: Multiplan Commercial |
$149.53
|
|
|
HC SOM TCP 88184
|
Facility
|
OP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$691.53 |
| Rate for Payer: Cigna of CA HMO/PPO |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.22
|
| 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 HMO/PPO |
$370.36
|
| Rate for Payer: Blue Shield of California Commercial |
$269.52
|
| Rate for Payer: Blue Shield of California EPN |
$216.74
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Cash Price |
$199.38
|
| 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: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.42
|
| Rate for Payer: Heritage Provider Network Senior |
$123.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$149.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| 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 |
$1.62 |
| Max. Negotiated Rate |
$246.93 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.52
|
| 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 HMO/PPO |
$246.93
|
| Rate for Payer: Blue Shield of California Commercial |
$204.88
|
| Rate for Payer: Blue Shield of California EPN |
$164.33
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| 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: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.53
|
| Rate for Payer: Heritage Provider Network Senior |
$5.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.47
|
| Rate for Payer: TriValley Medical Group Senior |
$25.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.50
|
| 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 |
$1.62 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.05
|
| Rate for Payer: Heritage Provider Network Senior |
$6.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
|
|
HC SOM TESTOSTERONE TOTAL
|
Facility
|
IP
|
$9.06
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900915375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Adventist Health Commercial |
$1.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.83
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.13
|
| Rate for Payer: Heritage Provider Network Senior |
$6.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$6.79
|
|
|
HC SOM TESTOSTERONE TOTAL
|
Facility
|
OP
|
$9.06
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900915375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$245.08 |
| Rate for Payer: Adventist Health Commercial |
$1.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.60
|
| 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 HMO/PPO |
$245.08
|
| Rate for Payer: Blue Shield of California Commercial |
$207.82
|
| Rate for Payer: Blue Shield of California EPN |
$166.69
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.89
|
| 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: EPIC Health Plan Commercial |
$5.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$6.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| 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
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| 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 HMO/PPO |
$142.35
|
| Rate for Payer: Blue Shield of California Commercial |
$120.67
|
| Rate for Payer: Blue Shield of California EPN |
$96.79
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| 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: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| 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 TGFBR2 FULL SEQUENCE
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$246.61 |
| Max. Negotiated Rate |
$1,021.88 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.45
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$922.41
|
| Rate for Payer: Heritage Provider Network Senior |
$922.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
|
|
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 |
$185.20 |
| Max. Negotiated Rate |
$1,420.92 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$842.02
|
| 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 HMO/PPO |
$1,420.92
|
| Rate for Payer: Blue Shield of California Commercial |
$831.12
|
| Rate for Payer: Blue Shield of California EPN |
$664.90
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$885.62
|
| 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: EPIC Health Plan Commercial |
$885.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$843.39
|
| Rate for Payer: Heritage Provider Network Senior |
$843.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$649.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| 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
|
OP
|
$36.14
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$176.94 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.33
|
| 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 HMO/PPO |
$176.94
|
| Rate for Payer: Blue Shield of California Commercial |
$176.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.74
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.49
|
| 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: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.37
|
| Rate for Payer: Heritage Provider Network Senior |
$22.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| 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 THALLIUM URINE
|
Facility
|
IP
|
$36.14
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$27.11 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.27
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.47
|
| Rate for Payer: Heritage Provider Network Senior |
$24.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$27.11
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.35
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$215.74 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.53
|
| 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 HMO/PPO |
$215.74
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.54
|
| 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: EPIC Health Plan Commercial |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.56
|
| Rate for Payer: Heritage Provider Network Senior |
$19.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| 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 |
$138.26
|
| 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 |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 THIOPURINE METAB
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC SOM THYROBLUBULIN AB
|
Facility
|
IP
|
$10.57
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.81
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.16
|
| Rate for Payer: Heritage Provider Network Senior |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
|
|
HC SOM THYROBLUBULIN AB
|
Facility
|
OP
|
$10.57
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$150.98 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.53
|
| 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 |
$150.98
|
| 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 |
$10.57
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.87
|
| 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: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.54
|
| Rate for Payer: Heritage Provider Network Senior |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| 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: Aetna of CA Non-Gatekeeper |
$14.67
|
| 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 Foundation Hospitals 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 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 |
$150.98 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.08
|
| 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 |
$150.98
|
| 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 Medicare Advantage |
$15.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| 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) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.32
|
| 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 TUMOR MARKER AB
|
Facility
|
OP
|
$9.09
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$150.98 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.62
|
| 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 |
$150.98
|
| 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 |
$9.09
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.91
|
| 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: EPIC Health Plan Commercial |
$5.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.63
|
| Rate for Payer: Heritage Provider Network Senior |
$5.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| 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 TUMOR MARKER AB
|
Facility
|
IP
|
$9.09
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.85
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.15
|
| Rate for Payer: Heritage Provider Network Senior |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
|
|
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 |
$1.66 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.67
|
| 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 |
$155.52
|
| 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 |
$9.18
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| 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
|
|
