|
HC LAB REF ENTEROVIRUS AB COXSACKIE B4
|
Facility
|
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B5
|
Facility
|
OP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B5
|
Facility
|
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B6
|
Facility
|
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B6
|
Facility
|
OP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 1
|
Facility
|
IP
|
$25.42
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.06 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.46
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.21
|
| Rate for Payer: Heritage Provider Network Senior |
$17.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 1
|
Facility
|
OP
|
$25.42
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.73
|
| Rate for Payer: Heritage Provider Network Senior |
$15.73
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 2
|
Facility
|
OP
|
$25.42
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912741
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.73
|
| Rate for Payer: Heritage Provider Network Senior |
$15.73
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 2
|
Facility
|
IP
|
$25.42
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912741
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.06 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.46
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.21
|
| Rate for Payer: Heritage Provider Network Senior |
$17.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$19.06
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
OP
|
$25.43
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.74
|
| Rate for Payer: Heritage Provider Network Senior |
$15.74
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$19.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
IP
|
$25.43
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Adventist Health Commercial |
$5.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.47
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.22
|
| Rate for Payer: Heritage Provider Network Senior |
$17.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$19.07
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
IP
|
$17.26
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
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 EPI CELL AB BMZ
|
Facility
|
OP
|
$17.26
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
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 |
$13.46
|
| 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 FISH ANEUPLOIDY REFLEX, POC
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912706
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC LAB REF FISH ANEUPLOIDY REFLEX, POC
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912706
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$31.05
|
| Rate for Payer: Blue Shield of California EPN |
$29.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Senior |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$43.47
|
| Rate for Payer: Blue Shield of California EPN |
$41.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Senior |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
|
OP
|
$565.88
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Adventist Health Commercial |
$113.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$351.41
|
| Rate for Payer: Blue Shield of California EPN |
$332.17
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.00
|
| Rate for Payer: Dignity Health Senior |
$481.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.28
|
| Rate for Payer: Heritage Provider Network Senior |
$350.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$272.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.47
|
| Rate for Payer: Multiplan Commercial |
$424.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.00
|
| Rate for Payer: Vantage Medical Group Senior |
$481.00
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
|
IP
|
$565.88
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.42 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Adventist Health Commercial |
$113.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.76
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.10
|
| Rate for Payer: Heritage Provider Network Senior |
$383.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.47
|
| Rate for Payer: Multiplan Commercial |
$424.41
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
|
OP
|
$430.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$365.74 |
| Rate for Payer: Adventist Health Commercial |
$86.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$267.20
|
| Rate for Payer: Blue Shield of California EPN |
$252.57
|
| Rate for Payer: Cash Price |
$193.63
|
| Rate for Payer: Cash Price |
$193.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$279.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.74
|
| Rate for Payer: Dignity Health Senior |
$365.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.34
|
| Rate for Payer: Heritage Provider Network Senior |
$266.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.57
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.74
|
| Rate for Payer: Vantage Medical Group Senior |
$365.74
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
|
IP
|
$430.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$322.71 |
| Rate for Payer: Adventist Health Commercial |
$86.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.60
|
| Rate for Payer: Cash Price |
$193.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.30
|
| Rate for Payer: Heritage Provider Network Senior |
$291.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.57
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
|
IP
|
$262.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.51 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Adventist Health Commercial |
$52.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.34
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.71
|
| Rate for Payer: Heritage Provider Network Senior |
$177.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.62
|
| Rate for Payer: Multiplan Commercial |
$196.88
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
|
OP
|
$262.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$223.12 |
| Rate for Payer: Adventist Health Commercial |
$52.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$163.01
|
| Rate for Payer: Blue Shield of California EPN |
$154.09
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.12
|
| Rate for Payer: Dignity Health Senior |
$223.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.49
|
| Rate for Payer: Heritage Provider Network Senior |
$162.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.62
|
| Rate for Payer: Multiplan Commercial |
$196.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.12
|
| Rate for Payer: Vantage Medical Group Senior |
$223.12
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
|
OP
|
$6.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.02
|
| Rate for Payer: Heritage Provider Network Senior |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.52
|
|
