|
HC SOM THYROGLOBULIN TUMOR MARKER TM
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900912645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.91
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
|
|
HC SOM THYROID BINDING GLOBULIN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$131.17 |
| 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 |
$22.17
|
| 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 |
$131.17
|
| 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 |
$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 |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.78
|
| 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 |
$14.78
|
| 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 |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| 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
|
$25.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
900911006
|
|
Hospital Revenue Code
|
301
|
| 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 THYROID STIMULATING IG
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
900915372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$409.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.29
|
| Rate for Payer: Blue Shield of California Commercial |
$409.25
|
| Rate for Payer: Blue Shield of California EPN |
$328.25
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.86
|
| Rate for Payer: TriValley Medical Group Senior |
$50.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.86
|
|
|
HC SOM THYROID STIMULATING IG
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
900915372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.69
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
HC SOM THYROPEROXIDASE AB
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.44
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM THYROPEROXIDASE AB
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$139.03 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| 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 |
$139.03
|
| 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 |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| 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
|
$15.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| 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 |
$122.92
|
| 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 |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| 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
|
$15.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912541
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| 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 Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM THYROXINE (T4), FREE
|
Facility
|
IP
|
$29.39
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$22.04 |
| Rate for Payer: Adventist Health Commercial |
$5.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.93
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.90
|
| Rate for Payer: Heritage Provider Network Senior |
$19.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.35
|
| Rate for Payer: Multiplan Commercial |
$22.04
|
|
|
HC SOM THYROXINE (T4), FREE
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900911005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$85.59 |
| Rate for Payer: Adventist Health Commercial |
$5.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.16
|
| 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 |
$85.59
|
| 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 |
$29.39
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.19
|
| Rate for Payer: Heritage Provider Network Senior |
$18.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$22.04
|
| 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 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 |
$6.34
|
| 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 Foundation Hospitals 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 |
$65.26 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.08
|
| 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 |
$65.26
|
| 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 Medicare Advantage |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| 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) Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.21
|
| 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 Non-Gatekeeper |
$54.79
|
| 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 |
$103.11
|
| 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 Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.31
|
| 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) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.33
|
| 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: Aetna of CA Non-Gatekeeper |
$57.10
|
| 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 Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$209.30
|
| 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 Foundation Hospitals 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 |
$29.95 |
| Max. Negotiated Rate |
$276.25 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.85
|
| 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 |
$177.38
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$155.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.69
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
|
|
HC SOM TISSUE TRANSGLT AB IGA
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.34
|
| 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 |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| 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 |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.12
|
| 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 |
$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 Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.57
|
| 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) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| 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 |
$12.63
|
| 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 Foundation Hospitals 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 |
$11.27
|
| 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 Foundation Hospitals 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 |
$140.63 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.81
|
| 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 |
$140.63
|
| 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 Medicare Advantage |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.32
|
| 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) Medicare Advantage |
$11.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.97
|
| 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
|
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 |
$99.84
|
| 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 Foundation Hospitals Medi-Cal |
$28.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.76
|
| Rate for Payer: Multiplan Commercial |
$116.27
|
|
|
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 |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$31.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| 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 Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.47
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$73.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| 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
|
|
