|
HC LAB REF ACH RECEPTOR MODULATING ABS
|
Facility
|
IP
|
$19.35
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.29
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.10
|
| Rate for Payer: Heritage Provider Network Senior |
$13.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.51
|
|
|
HC LAB REF ACOMPARATIVE GENE HYBRIDIZATIO
|
Facility
|
OP
|
$915.50
|
|
|
Service Code
|
CPT 81228
|
| Hospital Charge Code |
900912780
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$165.71 |
| Max. Negotiated Rate |
$2,272.92 |
| Rate for Payer: Adventist Health Commercial |
$183.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$446.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,350.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,272.92
|
| Rate for Payer: Blue Shield of California Commercial |
$568.53
|
| Rate for Payer: Blue Shield of California EPN |
$537.40
|
| Rate for Payer: Cash Price |
$411.98
|
| Rate for Payer: Cash Price |
$411.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$595.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,350.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$990.00
|
| Rate for Payer: Dignity Health Senior |
$900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$900.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.69
|
| Rate for Payer: Heritage Provider Network Senior |
$566.69
|
| Rate for Payer: Humana Medicare |
$900.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,710.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$686.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$900.00
|
| Rate for Payer: TriValley Medical Group Senior |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$972.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$972.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Vantage Medical Group Senior |
$900.00
|
|
|
HC LAB REF ACOMPARATIVE GENE HYBRIDIZATIO
|
Facility
|
IP
|
$915.50
|
|
|
Service Code
|
CPT 81228
|
| Hospital Charge Code |
900912780
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$165.71 |
| Max. Negotiated Rate |
$686.62 |
| Rate for Payer: Adventist Health Commercial |
$183.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.95
|
| Rate for Payer: Cash Price |
$411.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$619.79
|
| Rate for Payer: Heritage Provider Network Senior |
$619.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.88
|
| Rate for Payer: Multiplan Commercial |
$686.62
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
IP
|
$35.95
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Adventist Health Commercial |
$7.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.70
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.34
|
| Rate for Payer: Heritage Provider Network Senior |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Multiplan Commercial |
$26.96
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
OP
|
$35.95
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$210.08 |
| Rate for Payer: Adventist Health Commercial |
$7.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.08
|
| Rate for Payer: Blue Shield of California Commercial |
$196.04
|
| Rate for Payer: Blue Shield of California EPN |
$153.26
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.25
|
| Rate for Payer: Heritage Provider Network Senior |
$22.25
|
| Rate for Payer: Humana Medicare |
$33.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$26.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC LAB REF AEROBIC ROUTINE MIC PANEL
|
Facility
|
IP
|
$12.38
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.51
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.38
|
| Rate for Payer: Heritage Provider Network Senior |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$9.28
|
|
|
HC LAB REF AEROBIC ROUTINE MIC PANEL
|
Facility
|
OP
|
$12.38
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California EPN |
$52.79
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.66
|
| Rate for Payer: Heritage Provider Network Senior |
$7.66
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$9.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC LAB REF ALBUMIN CHARGE - SO
|
Facility
|
OP
|
$7.09
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.47
|
| Rate for Payer: Blue Shield of California Commercial |
$38.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4.39
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC LAB REF ALBUMIN CHARGE - SO
|
Facility
|
IP
|
$7.09
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.87
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.80
|
| Rate for Payer: Heritage Provider Network Senior |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
|
|
HC LAB REF ALCOHOL METHYL
|
Facility
|
IP
|
$70.09
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$52.57 |
| Rate for Payer: Adventist Health Commercial |
$14.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.15
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.45
|
| Rate for Payer: Heritage Provider Network Senior |
$47.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$52.57
|
|
|
HC LAB REF ALCOHOL METHYL
|
Facility
|
OP
|
$70.09
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Adventist Health Commercial |
$14.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.78
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.58
|
| Rate for Payer: Dignity Health Senior |
$59.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.39
|
| Rate for Payer: Heritage Provider Network Senior |
$43.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$52.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.58
|
| Rate for Payer: Vantage Medical Group Senior |
$59.58
|
|
|
HC LAB REF ALLERGEN INDIVIDUAL (RAST)
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900911010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
|
HC LAB REF ALLERGEN INDIVIDUAL (RAST)
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900911010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LAB REF AMPHOTERICIN B
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Blue Shield of California Commercial |
$55.89
|
| Rate for Payer: Blue Shield of California EPN |
$52.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC LAB REF AMPHOTERICIN B
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC LAB REF AMPICILIIN
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$17.06 |
| Rate for Payer: Adventist Health Commercial |
$4.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.63
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.40
|
| Rate for Payer: Heritage Provider Network Senior |
$15.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$17.06
|
|
|
HC LAB REF AMPICILIIN
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$4.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.63
|
| 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 |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.08
|
| Rate for Payer: Heritage Provider Network Senior |
$14.08
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$17.06
|
| 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 LAB REF ANTI-EPITHELIAL AB
|
Facility
|
IP
|
$17.26
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
900911410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$12.94 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.69
|
| Rate for Payer: Heritage Provider Network Senior |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
|
|
HC LAB REF ANTI-EPITHELIAL AB
|
Facility
|
OP
|
$17.26
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
900911410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.68
|
| Rate for Payer: Heritage Provider Network Senior |
$10.68
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC LAB REF ANTI-PM1 AB
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900911424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC LAB REF ANTI-PM1 AB
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900911424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC LAB REF ASPERGILLUS AB
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900911117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$117.56
|
| Rate for Payer: Blue Shield of California EPN |
$91.90
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.56
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.64
|
| Rate for Payer: Heritage Provider Network Senior |
$24.64
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$29.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC LAB REF ASPERGILLUS AB
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900911117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.34
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.94
|
| Rate for Payer: Heritage Provider Network Senior |
$26.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.95
|
| Rate for Payer: Multiplan Commercial |
$29.85
|
|
|
HC LAB REF BIOTINADASE
|
Facility
|
OP
|
$24.16
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
900910727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$140.54 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.54
|
| Rate for Payer: Blue Shield of California Commercial |
$131.76
|
| Rate for Payer: Blue Shield of California EPN |
$103.00
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.96
|
| Rate for Payer: Heritage Provider Network Senior |
$14.96
|
| Rate for Payer: Humana Medicare |
$16.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC LAB REF BIOTINADASE
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
900910727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.60
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.36
|
| Rate for Payer: Heritage Provider Network Senior |
$16.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
|
