|
HC LAB REF CHROMOSOMES SCE
|
Facility
|
IP
|
$505.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$91.46 |
| Max. Negotiated Rate |
$378.96 |
| Rate for Payer: Adventist Health Commercial |
$101.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$347.13
|
| Rate for Payer: Cash Price |
$227.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.07
|
| Rate for Payer: Heritage Provider Network Senior |
$342.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.32
|
| Rate for Payer: Multiplan Commercial |
$378.96
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
OP
|
$100.83
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$20.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.41
|
| Rate for Payer: Heritage Provider Network Senior |
$62.41
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$75.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
IP
|
$100.83
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$75.62 |
| Rate for Payer: Adventist Health Commercial |
$20.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.27
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.26
|
| Rate for Payer: Heritage Provider Network Senior |
$68.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.21
|
| Rate for Payer: Multiplan Commercial |
$75.62
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
IP
|
$178.53
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Adventist Health Commercial |
$35.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.65
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.86
|
| Rate for Payer: Heritage Provider Network Senior |
$120.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.63
|
| Rate for Payer: Multiplan Commercial |
$133.90
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
OP
|
$178.53
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$1,043.23 |
| Rate for Payer: Adventist Health Commercial |
$35.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,043.23
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.51
|
| Rate for Payer: Heritage Provider Network Senior |
$110.51
|
| Rate for Payer: Humana Medicare |
$125.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$133.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
OP
|
$238.22
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$1,392.04 |
| Rate for Payer: Adventist Health Commercial |
$47.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$483.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,392.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,015.50
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$154.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Senior |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.46
|
| Rate for Payer: Heritage Provider Network Senior |
$147.46
|
| Rate for Payer: Humana Medicare |
$173.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.81
|
| Rate for Payer: Multiplan Commercial |
$178.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$173.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
IP
|
$238.22
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$178.66 |
| Rate for Payer: Adventist Health Commercial |
$47.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.66
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.27
|
| Rate for Payer: Heritage Provider Network Senior |
$161.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.56
|
| Rate for Payer: Multiplan Commercial |
$178.66
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
IP
|
$14.47
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.94
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.80
|
| Rate for Payer: Heritage Provider Network Senior |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
OP
|
$14.47
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$38.21 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.21
|
| Rate for Payer: Blue Shield of California Commercial |
$35.83
|
| Rate for Payer: Blue Shield of California EPN |
$28.01
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Senior |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.96
|
| Rate for Payer: Heritage Provider Network Senior |
$8.96
|
| Rate for Payer: Humana Medicare |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.47
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.07
|
| Rate for Payer: TriValley Medical Group Senior |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
OP
|
$87.16
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.90
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Blue Shield of California EPN |
$81.15
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.95
|
| Rate for Payer: Heritage Provider Network Senior |
$53.95
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$65.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
IP
|
$87.16
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$65.37 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.88
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.01
|
| Rate for Payer: Heritage Provider Network Senior |
$59.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$65.37
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
IP
|
$50.05
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.38
|
| Rate for Payer: Cash Price |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.88
|
| Rate for Payer: Heritage Provider Network Senior |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.51
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
OP
|
$50.05
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.90
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Blue Shield of California EPN |
$81.15
|
| Rate for Payer: Cash Price |
$22.52
|
| Rate for Payer: Cash Price |
$22.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.98
|
| Rate for Payer: Heritage Provider Network Senior |
$30.98
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.76
|
| Rate for Payer: Blue Shield of California Commercial |
$120.18
|
| Rate for Payer: Blue Shield of California EPN |
$93.96
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Senior |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Humana Medicare |
$15.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.39
|
| Rate for Payer: TriValley Medical Group Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
|
OP
|
$22.04
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.76
|
| Rate for Payer: Blue Shield of California Commercial |
$120.18
|
| Rate for Payer: Blue Shield of California EPN |
$93.96
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Senior |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.64
|
| Rate for Payer: Heritage Provider Network Senior |
$13.64
|
| Rate for Payer: Humana Medicare |
$15.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.39
|
| Rate for Payer: TriValley Medical Group Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
|
IP
|
$22.04
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.14
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
|
|
HC LAB REF CYCLIC AMP URINE
|
Facility
|
OP
|
$36.95
|
|
|
Service Code
|
CPT 82030
|
| Hospital Charge Code |
900911047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$215.88 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.88
|
| Rate for Payer: Blue Shield of California Commercial |
$201.52
|
| Rate for Payer: Blue Shield of California EPN |
$157.54
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.38
|
| Rate for Payer: Dignity Health Senior |
$25.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.87
|
| Rate for Payer: Heritage Provider Network Senior |
$22.87
|
| Rate for Payer: Humana Medicare |
$25.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.51
|
| Rate for Payer: Multiplan Commercial |
$27.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.38
|
| Rate for Payer: Vantage Medical Group Senior |
$25.80
|
|
|
HC LAB REF CYCLIC AMP URINE
|
Facility
|
IP
|
$36.95
|
|
|
Service Code
|
CPT 82030
|
| Hospital Charge Code |
900911047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$27.71 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.38
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.02
|
| Rate for Payer: Heritage Provider Network Senior |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$27.71
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
|
IP
|
$125.55
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.25
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.00
|
| Rate for Payer: Heritage Provider Network Senior |
$85.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
|
OP
|
$125.55
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.70
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.72
|
| Rate for Payer: Dignity Health Senior |
$106.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.72
|
| Rate for Payer: Heritage Provider Network Senior |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.72
|
| Rate for Payer: Vantage Medical Group Senior |
$106.72
|
|
|
HC LAB REF DNA PROBE
|
Facility
|
OP
|
$30.68
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912580
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.84
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Senior |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.99
|
| Rate for Payer: Heritage Provider Network Senior |
$18.99
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC LAB REF DNA PROBE
|
Facility
|
IP
|
$30.68
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912580
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.77
|
| Rate for Payer: Heritage Provider Network Senior |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
|
|
HC LAB REF DOT/SLOT BLOT NA EA
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
CPT 83893
|
| Hospital Charge Code |
900912785
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
|
|
HC LAB REF DOT/SLOT BLOT NA EA
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
CPT 83893
|
| Hospital Charge Code |
900912785
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
