|
HC LAB REF PHOSPHOTIDYLSERINE IGG
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.24
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$98.06
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Humana Medicare |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGG
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.06 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGM
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911383
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.24
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$98.06
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Humana Medicare |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC LAB REF PHOSPHOTIDYLSERINE IGM
|
Facility
|
IP
|
$44.09
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900911383
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.07 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.29
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.85
|
| Rate for Payer: Heritage Provider Network Senior |
$29.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
|
|
HC LAB REF PROSTAGLANINS PGE2
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900910778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.89
|
| Rate for Payer: Blue Shield of California Commercial |
$194.98
|
| Rate for Payer: Blue Shield of California EPN |
$152.43
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.95
|
| Rate for Payer: Dignity Health Senior |
$41.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.84
|
| Rate for Payer: Heritage Provider Network Senior |
$222.84
|
| Rate for Payer: Humana Medicare |
$41.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.63
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.77
|
| Rate for Payer: TriValley Medical Group Senior |
$41.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.77
|
|
|
HC LAB REF PROSTAGLANINS PGE2
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900910778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.16 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.32
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.72
|
| Rate for Payer: Heritage Provider Network Senior |
$243.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
|
|
HC LAB REF PROTEIN ELECT BODY FLUID
|
Facility
|
IP
|
$24.91
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.11
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.86
|
| Rate for Payer: Heritage Provider Network Senior |
$16.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$18.68
|
|
|
HC LAB REF PROTEIN ELECT BODY FLUID
|
Facility
|
OP
|
$24.91
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$146.23 |
| Rate for Payer: Adventist Health Commercial |
$4.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.23
|
| Rate for Payer: Blue Shield of California Commercial |
$139.30
|
| Rate for Payer: Blue Shield of California EPN |
$108.90
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.42
|
| Rate for Payer: Heritage Provider Network Senior |
$15.42
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC LAB REF PROTEIN TOTAL (SO)
|
Facility
|
OP
|
$31.73
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$6.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.65
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| Rate for Payer: Cash Price |
$14.28
|
| Rate for Payer: Cash Price |
$14.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.64
|
| Rate for Payer: Heritage Provider Network Senior |
$19.64
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$23.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC LAB REF PROTEIN TOTAL (SO)
|
Facility
|
IP
|
$31.73
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$6.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.80
|
| Rate for Payer: Cash Price |
$14.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.48
|
| Rate for Payer: Heritage Provider Network Senior |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$23.80
|
|
|
HC LAB REF PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$52.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.70
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.04
|
| Rate for Payer: Dignity Health Senior |
$45.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.80
|
| Rate for Payer: Heritage Provider Network Senior |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.04
|
| Rate for Payer: Vantage Medical Group Senior |
$45.04
|
|
|
HC LAB REF PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$52.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$39.74 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.40
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.87
|
| Rate for Payer: Heritage Provider Network Senior |
$35.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.74
|
|
|
HC LAB REF QUINIDINE
|
Facility
|
IP
|
$59.40
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
900910456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: Adventist Health Commercial |
$11.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.81
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.21
|
| Rate for Payer: Heritage Provider Network Senior |
$40.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.85
|
| Rate for Payer: Multiplan Commercial |
$44.55
|
|
|
HC LAB REF QUINIDINE
|
Facility
|
OP
|
$59.40
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
900910456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$122.17 |
| Rate for Payer: Adventist Health Commercial |
$11.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.17
|
| Rate for Payer: Blue Shield of California Commercial |
$113.98
|
| Rate for Payer: Blue Shield of California EPN |
$89.10
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Senior |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$44.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Senior |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC LAB REF RAJI CELL
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$203.99 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.99
|
| Rate for Payer: Blue Shield of California Commercial |
$190.34
|
| Rate for Payer: Blue Shield of California EPN |
$148.80
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$24.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF RAJI CELL
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC LAB REF RENIN ACT PLASMA
|
Facility
|
OP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$184.10 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.10
|
| Rate for Payer: Blue Shield of California Commercial |
$171.78
|
| Rate for Payer: Blue Shield of California EPN |
$134.29
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.19
|
| Rate for Payer: Dignity Health Senior |
$21.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.49
|
| Rate for Payer: Heritage Provider Network Senior |
$8.49
|
| Rate for Payer: Humana Medicare |
$21.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.99
|
| Rate for Payer: TriValley Medical Group Senior |
$21.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.99
|
|
|
HC LAB REF RENIN ACT PLASMA
|
Facility
|
IP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.43
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
|
|
HC LAB REF REPTILASE TIME
|
Facility
|
IP
|
$14.10
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.69
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.55
|
| Rate for Payer: Heritage Provider Network Senior |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.52
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
|
|
HC LAB REF REPTILASE TIME
|
Facility
|
OP
|
$14.10
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$82.44 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.44
|
| Rate for Payer: Blue Shield of California Commercial |
$76.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.13
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.84
|
| Rate for Payer: Dignity Health Senior |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.73
|
| Rate for Payer: Heritage Provider Network Senior |
$8.73
|
| Rate for Payer: Humana Medicare |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.41
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.85
|
| Rate for Payer: TriValley Medical Group Senior |
$9.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
HC LAB REF RETICULIN AB
|
Facility
|
IP
|
$12.16
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.35
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Senior |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
|
|
HC LAB REF RETICULIN AB
|
Facility
|
OP
|
$12.16
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.35
|
| 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 |
$5.47
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.90
|
| 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 |
$7.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7.53
|
| 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 |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| 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 |
$9.12
|
| 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 RIFAMPIN
|
Facility
|
OP
|
$122.26
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$24.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.68
|
| Rate for Payer: Heritage Provider Network Senior |
$75.68
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$91.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC LAB REF RIFAMPIN
|
Facility
|
IP
|
$122.26
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Adventist Health Commercial |
$24.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.99
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.77
|
| Rate for Payer: Heritage Provider Network Senior |
$82.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: Multiplan Commercial |
$91.70
|
|
|
HC LAB REF RISPERIDONE
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$64.47 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.05
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.49
|
| Rate for Payer: Multiplan Commercial |
$64.47
|
|
