|
HC LAB REF LCM IGM
|
Facility
|
IP
|
$39.10
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
900912723
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$29.32 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.86
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.47
|
| Rate for Payer: Heritage Provider Network Senior |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$29.32
|
|
|
HC LAB REF LCM IGM
|
Facility
|
OP
|
$39.10
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
900912723
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.51
|
| Rate for Payer: Blue Shield of California EPN |
$78.57
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$29.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC LAB REF LIDOCAINE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
900910404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$122.90 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.90
|
| Rate for Payer: Blue Shield of California Commercial |
$114.71
|
| Rate for Payer: Blue Shield of California EPN |
$89.67
|
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.16
|
| Rate for Payer: Dignity Health Senior |
$14.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.05
|
| Rate for Payer: Heritage Provider Network Senior |
$10.05
|
| Rate for Payer: Humana Medicare |
$14.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.51
|
| Rate for Payer: Multiplan Commercial |
$12.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.69
|
| Rate for Payer: TriValley Medical Group Senior |
$14.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.16
|
| Rate for Payer: Vantage Medical Group Senior |
$14.69
|
|
|
HC LAB REF LIDOCAINE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
900910404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.18 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.16
|
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.99
|
| Rate for Payer: Heritage Provider Network Senior |
$10.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.18
|
|
|
HC LAB REF LISTERIA AB
|
Facility
|
OP
|
$98.57
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
900911391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$19.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.72
|
| 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 |
$44.36
|
| Rate for Payer: Cash Price |
$44.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.07
|
| 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 |
$64.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Senior |
$61.01
|
| 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 |
$17.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.64
|
| 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 |
$73.93
|
| 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 LISTERIA AB
|
Facility
|
IP
|
$98.57
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
900911391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$73.93 |
| Rate for Payer: Adventist Health Commercial |
$19.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.72
|
| Rate for Payer: Cash Price |
$44.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.73
|
| Rate for Payer: Heritage Provider Network Senior |
$66.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$73.93
|
|
|
HC LAB REF MERCURY URINE
|
Facility
|
IP
|
$20.75
|
|
|
Service Code
|
CPT 83830
|
| Hospital Charge Code |
900911144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.26
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.05
|
| Rate for Payer: Heritage Provider Network Senior |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.19
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
|
|
HC LAB REF MERCURY URINE
|
Facility
|
OP
|
$20.75
|
|
|
Service Code
|
CPT 83830
|
| Hospital Charge Code |
900911144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.56
|
| Rate for Payer: Blue Shield of California Commercial |
$12.89
|
| Rate for Payer: Blue Shield of California EPN |
$12.18
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.64
|
| Rate for Payer: Dignity Health Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.84
|
| Rate for Payer: Heritage Provider Network Senior |
$12.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.19
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.64
|
| Rate for Payer: Vantage Medical Group Senior |
$17.64
|
|
|
HC LAB REF METHEMALBUMIN
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83857
|
| Hospital Charge Code |
900911067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC LAB REF METHEMALBUMIN
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83857
|
| Hospital Charge Code |
900911067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$89.88 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.88
|
| Rate for Payer: Blue Shield of California Commercial |
$83.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.59
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Senior |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Humana Medicare |
$10.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC LAB REF METHEMOGLOBIN
|
Facility
|
OP
|
$8.62
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900910295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$61.31 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.31
|
| Rate for Payer: Blue Shield of California Commercial |
$57.19
|
| Rate for Payer: Blue Shield of California EPN |
$44.71
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Senior |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5.34
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.20
|
| Rate for Payer: TriValley Medical Group Senior |
$8.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
HC LAB REF METHEMOGLOBIN
|
Facility
|
IP
|
$8.62
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900910295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.92
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.84
|
| Rate for Payer: Heritage Provider Network Senior |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
|
|
HC LAB REF MITOCHONDRIAL DNA
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$807.22
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.48
|
| Rate for Payer: Heritage Provider Network Senior |
$795.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
|
|
HC LAB REF MITOCHONDRIAL DNA
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$998.75 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$628.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$807.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$998.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$646.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.25
|
| Rate for Payer: Blue Shield of California Commercial |
$729.68
|
| Rate for Payer: Blue Shield of California EPN |
$689.72
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$763.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$998.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.75
|
| Rate for Payer: Dignity Health Senior |
$998.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.32
|
| Rate for Payer: Heritage Provider Network Senior |
$727.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$566.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.75
|
| Rate for Payer: Vantage Medical Group Senior |
$998.75
|
|
|
HC LAB REF MMR MUMPS IGG IFA
|
Facility
|
OP
|
$48.36
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$9.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.67
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.93
|
| Rate for Payer: Heritage Provider Network Senior |
$29.93
|
| Rate for Payer: Humana Medicare |
$13.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$36.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC LAB REF MMR MUMPS IGG IFA
|
Facility
|
IP
|
$48.36
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$36.27 |
| Rate for Payer: Adventist Health Commercial |
$9.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.22
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.74
|
| Rate for Payer: Heritage Provider Network Senior |
$32.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$36.27
|
|
|
HC LAB REF MMR RUBELLA IGG ELISA
|
Facility
|
OP
|
$53.32
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900912871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$112.41
|
| Rate for Payer: Blue Shield of California EPN |
$87.88
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.01
|
| Rate for Payer: Heritage Provider Network Senior |
$33.01
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC LAB REF MMR RUBELLA IGG ELISA
|
Facility
|
IP
|
$53.32
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900912871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$39.99 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.63
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.10
|
| Rate for Payer: Heritage Provider Network Senior |
$36.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.33
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
|
|
HC LAB REF MMR RUBEOLA IGG IFA
|
Facility
|
OP
|
$47.74
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912869
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$9.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.80
|
| 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 |
$21.48
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.03
|
| 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 |
$31.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.55
|
| Rate for Payer: Heritage Provider Network Senior |
$29.55
|
| 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 |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| 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 |
$35.80
|
| 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 MMR RUBEOLA IGG IFA
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912869
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Adventist Health Commercial |
$9.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.80
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.32
|
| Rate for Payer: Heritage Provider Network Senior |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: Multiplan Commercial |
$35.80
|
|
|
HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO
|
Facility
|
IP
|
$30.68
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900910683
|
|
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 MOLECULAR CYTOGENETICS,DNA PRO
|
Facility
|
OP
|
$30.68
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900910683
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$1,420.05 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.05
|
| Rate for Payer: Blue Shield of California Commercial |
$167.31
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| 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 |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.99
|
| Rate for Payer: Heritage Provider Network Senior |
$18.99
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC LAB REF MOLECULAR CYTOGENTCS 100-300CE
|
Facility
|
IP
|
$57.52
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900910679
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$43.14 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.52
|
| Rate for Payer: Cash Price |
$25.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.94
|
| Rate for Payer: Heritage Provider Network Senior |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Multiplan Commercial |
$43.14
|
|
|
HC LAB REF MOLECULAR CYTOGENTCS 100-300CE
|
Facility
|
OP
|
$57.52
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900910679
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$2,190.93 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,190.93
|
| Rate for Payer: Blue Shield of California Commercial |
$313.65
|
| Rate for Payer: Blue Shield of California EPN |
$245.20
|
| Rate for Payer: Cash Price |
$25.88
|
| Rate for Payer: Cash Price |
$25.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.60
|
| Rate for Payer: Heritage Provider Network Senior |
$35.60
|
| Rate for Payer: Humana Medicare |
$51.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$43.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC LAB REF MORPHOMETRIC ANALYSIS IN SITU
|
Facility
|
IP
|
$64.90
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
900912796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$48.68 |
| Rate for Payer: Adventist Health Commercial |
$12.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.59
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.94
|
| Rate for Payer: Heritage Provider Network Senior |
$43.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$48.68
|
|
