|
HC LAB REF GAMMA GLOBULIN SUBCLASS
|
Facility
|
OP
|
$19.47
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$278.82 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.82
|
| Rate for Payer: Blue Shield of California Commercial |
$62.61
|
| Rate for Payer: Blue Shield of California EPN |
$48.94
|
| Rate for Payer: Cash Price |
$8.76
|
| Rate for Payer: Cash Price |
$8.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Senior |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Humana Medicare |
$8.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.11
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC LAB REF GAMMA GLOBULIN SUBCLASS
|
Facility
|
IP
|
$19.47
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.38
|
| Rate for Payer: Cash Price |
$8.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.18
|
| Rate for Payer: Heritage Provider Network Senior |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
|
|
HC LAB REF GREEN COFFEE BEAN IGE
|
Facility
|
IP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
|
|
HC LAB REF GREEN COFFEE BEAN IGE
|
Facility
|
OP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| 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 |
$5.36
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.74
|
| 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 |
$7.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.37
|
| Rate for Payer: Heritage Provider Network Senior |
$7.37
|
| 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 |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| 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 |
$8.92
|
| 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 HEAVY METALS UR ARSENIC
|
Facility
|
IP
|
$19.85
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900912663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.64
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.44
|
| Rate for Payer: Heritage Provider Network Senior |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
|
|
HC LAB REF HEAVY METALS UR ARSENIC
|
Facility
|
OP
|
$19.85
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900912663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$158.80 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.80
|
| Rate for Payer: Blue Shield of California Commercial |
$148.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.85
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Senior |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.29
|
| Rate for Payer: Heritage Provider Network Senior |
$12.29
|
| Rate for Payer: Humana Medicare |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.90
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC LAB REF HEAVY METALS UR CADMIUM
|
Facility
|
OP
|
$24.21
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900912662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$193.62 |
| Rate for Payer: Adventist Health Commercial |
$4.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.62
|
| Rate for Payer: Blue Shield of California Commercial |
$180.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.28
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Senior |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.99
|
| Rate for Payer: Heritage Provider Network Senior |
$14.99
|
| Rate for Payer: Humana Medicare |
$23.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$18.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.64
|
| Rate for Payer: TriValley Medical Group Senior |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC LAB REF HEAVY METALS UR CADMIUM
|
Facility
|
IP
|
$24.21
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900912662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Adventist Health Commercial |
$4.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.63
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.39
|
| Rate for Payer: Heritage Provider Network Senior |
$16.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$18.16
|
|
|
HC LAB REF HEAVY METALS UR LEAD
|
Facility
|
OP
|
$12.67
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900912661
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$101.32 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.32
|
| Rate for Payer: Blue Shield of California Commercial |
$94.53
|
| Rate for Payer: Blue Shield of California EPN |
$73.90
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.84
|
| Rate for Payer: Heritage Provider Network Senior |
$7.84
|
| Rate for Payer: Humana Medicare |
$12.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC LAB REF HEAVY METALS UR LEAD
|
Facility
|
IP
|
$12.67
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900912661
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.58
|
| Rate for Payer: Heritage Provider Network Senior |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
|
|
HC LAB REF HEAVY METALS UR MERCURY
|
Facility
|
OP
|
$17.01
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900912664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.47
|
| Rate for Payer: Blue Shield of California Commercial |
$127.00
|
| Rate for Payer: Blue Shield of California EPN |
$99.29
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Senior |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.53
|
| Rate for Payer: Heritage Provider Network Senior |
$10.53
|
| Rate for Payer: Humana Medicare |
$16.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.26
|
| Rate for Payer: TriValley Medical Group Senior |
$16.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC LAB REF HEAVY METALS UR MERCURY
|
Facility
|
IP
|
$17.01
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900912664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.69
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.52
|
| Rate for Payer: Heritage Provider Network Senior |
$11.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.76
|
|
|
HC LAB REF HERPESVIRUS 6 AB IGG
|
Facility
|
OP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900910749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.86
|
| Rate for Payer: Heritage Provider Network Senior |
$30.86
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF HERPESVIRUS 6 AB IGG
|
Facility
|
IP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900910749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.76
|
| Rate for Payer: Heritage Provider Network Senior |
$33.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
|
|
HC LAB REF HERPESVIRUS 6 AB, IGM
|
Facility
|
OP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.86
|
| Rate for Payer: Heritage Provider Network Senior |
$30.86
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF HERPESVIRUS 6 AB, IGM
|
Facility
|
IP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.76
|
| Rate for Payer: Heritage Provider Network Senior |
$33.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
|
|
HC LAB REF HIV 1
|
Facility
|
OP
|
$21.40
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900910666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.01
|
| Rate for Payer: Blue Shield of California Commercial |
$151.21
|
| Rate for Payer: Blue Shield of California EPN |
$118.21
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Senior |
$13.25
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$16.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF HIV 1
|
Facility
|
IP
|
$21.40
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900910666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.70
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.49
|
| Rate for Payer: Heritage Provider Network Senior |
$14.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Multiplan Commercial |
$16.05
|
|
|
HC LAB REF HIV 1/2 CONFIRM. EVAL
|
Facility
|
IP
|
$27.72
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Adventist Health Commercial |
$5.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.04
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.77
|
| Rate for Payer: Heritage Provider Network Senior |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
|
|
HC LAB REF HIV 1/2 CONFIRM. EVAL
|
Facility
|
OP
|
$27.72
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Adventist Health Commercial |
$5.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.01
|
| Rate for Payer: Blue Shield of California Commercial |
$151.21
|
| Rate for Payer: Blue Shield of California EPN |
$118.21
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.16
|
| Rate for Payer: Heritage Provider Network Senior |
$17.16
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF HPA ANTIBODIES
|
Facility
|
OP
|
$26.31
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900911214
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.45
|
| Rate for Payer: Blue Shield of California Commercial |
$143.44
|
| Rate for Payer: Blue Shield of California EPN |
$112.13
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.29
|
| Rate for Payer: Heritage Provider Network Senior |
$16.29
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.15
|
| Rate for Payer: Multiplan Commercial |
$19.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC LAB REF HPA ANTIBODIES
|
Facility
|
IP
|
$26.31
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900911214
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.07
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.81
|
| Rate for Payer: Heritage Provider Network Senior |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$19.73
|
|
|
HC LAB REF HSV 1/2 IGM CSF
|
Facility
|
IP
|
$106.50
|
|
| Hospital Charge Code |
900911351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$79.88 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.17
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.10
|
| Rate for Payer: Heritage Provider Network Senior |
$72.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.62
|
| Rate for Payer: Multiplan Commercial |
$79.88
|
|
|
HC LAB REF HSV 1/2 IGM CSF
|
Facility
|
OP
|
$106.50
|
|
| Hospital Charge Code |
900911351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$90.52 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.88
|
| Rate for Payer: Blue Shield of California Commercial |
$66.14
|
| Rate for Payer: Blue Shield of California EPN |
$62.52
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.52
|
| Rate for Payer: Dignity Health Senior |
$90.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.92
|
| Rate for Payer: Heritage Provider Network Senior |
$65.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.62
|
| Rate for Payer: Multiplan Commercial |
$79.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.52
|
| Rate for Payer: Vantage Medical Group Senior |
$90.52
|
|
|
HC LAB REF HSV 1 IGG
|
Facility
|
IP
|
$14.05
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900911468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.51
|
| Rate for Payer: Heritage Provider Network Senior |
$9.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$10.54
|
|
