|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.82
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.45
|
| Rate for Payer: Heritage Provider Network Senior |
$160.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$177.75
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
|
HC IMMUNOASSAY QUAN CA 15-3
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900912123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.39
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.23
|
| Rate for Payer: Heritage Provider Network Senior |
$146.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
|
|
HC IMMUNOASSAY QUAN CA 15-3
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900912123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 19-9
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900912124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 19-9
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900912124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
|
HC IMMUNOFLUORESCENCE STAIN EA AB
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
903800037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.17
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$104.49
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| 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 |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC IMMUNOFLUORESCENCE STAIN EA AB
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
903800037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.47 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.86
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.37
|
| Rate for Payer: Heritage Provider Network Senior |
$439.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.25
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
|
|
HC IMMUNOFLUORES STAIN EA ADDL
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
903800289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC IMMUNOFLUORES STAIN EA ADDL
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
903800289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$464.50
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$104.49
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Senior |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$137.83 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.83
|
| Rate for Payer: Blue Shield of California Commercial |
$128.63
|
| Rate for Payer: Blue Shield of California EPN |
$100.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Senior |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$16.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.46
|
| Rate for Payer: TriValley Medical Group Senior |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.53
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.53
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.47 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.86
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.37
|
| Rate for Payer: Heritage Provider Network Senior |
$439.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.25
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
OP
|
$178.30
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$35.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$139.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.79
|
| Rate for Payer: Blue Shield of California Commercial |
$110.72
|
| Rate for Payer: Blue Shield of California EPN |
$104.66
|
| Rate for Payer: Cash Price |
$80.24
|
| Rate for Payer: Cash Price |
$80.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.37
|
| Rate for Payer: Heritage Provider Network Senior |
$110.37
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$133.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
IP
|
$740.19
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.97 |
| Max. Negotiated Rate |
$555.14 |
| Rate for Payer: Adventist Health Commercial |
$148.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.51
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.11
|
| Rate for Payer: Heritage Provider Network Senior |
$501.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.05
|
| Rate for Payer: Multiplan Commercial |
$555.14
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
OP
|
$740.19
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$629.16 |
| Rate for Payer: Adventist Health Commercial |
$148.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.75
|
| Rate for Payer: Blue Shield of California Commercial |
$459.66
|
| Rate for Payer: Blue Shield of California EPN |
$434.49
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.16
|
| Rate for Payer: Dignity Health Senior |
$629.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.18
|
| Rate for Payer: Heritage Provider Network Senior |
$458.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$356.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.05
|
| Rate for Payer: Multiplan Commercial |
$555.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.16
|
| Rate for Payer: Vantage Medical Group Senior |
$629.16
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$730.50 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$669.14
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$659.40
|
| Rate for Payer: Heritage Provider Network Senior |
$659.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.50
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.85
|
| Rate for Payer: Blue Shield of California Commercial |
$103.71
|
| Rate for Payer: Blue Shield of California EPN |
$98.03
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
