|
HC LAB REF RISPERIDONE
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.04
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.07
|
| Rate for Payer: Dignity Health Senior |
$73.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.21
|
| Rate for Payer: Heritage Provider Network Senior |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.43
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.07
|
| Rate for Payer: Vantage Medical Group Senior |
$73.07
|
|
|
HC LAB REF SALMONELLA SEROTYPING
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Senior |
$87.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC LAB REF SALMONELLA SEROTYPING
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC LAB REF SCRUB TYPHUS
|
Facility
|
IP
|
$127.20
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
900912586
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$25.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.39
|
| Rate for Payer: Cash Price |
$57.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.11
|
| Rate for Payer: Heritage Provider Network Senior |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
|
|
HC LAB REF SCRUB TYPHUS
|
Facility
|
OP
|
$127.20
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
900912586
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$161.90 |
| Rate for Payer: Adventist Health Commercial |
$25.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.39
|
| 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 |
$161.90
|
| 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 |
$57.24
|
| Rate for Payer: Cash Price |
$57.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.68
|
| 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 |
$82.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.74
|
| Rate for Payer: Heritage Provider Network Senior |
$78.74
|
| 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 |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| 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 |
$95.40
|
| 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 SPERM IGG AB
|
Facility
|
OP
|
$87.30
|
|
|
Service Code
|
CPT 89325
|
| Hospital Charge Code |
900911439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$89.32 |
| Rate for Payer: Adventist Health Commercial |
$17.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.32
|
| Rate for Payer: Blue Shield of California Commercial |
$83.35
|
| Rate for Payer: Blue Shield of California EPN |
$65.16
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.74
|
| Rate for Payer: Dignity Health Senior |
$10.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.04
|
| Rate for Payer: Heritage Provider Network Senior |
$54.04
|
| Rate for Payer: Humana Medicare |
$10.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$65.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.67
|
| Rate for Payer: TriValley Medical Group Senior |
$10.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.67
|
|
|
HC LAB REF SPERM IGG AB
|
Facility
|
IP
|
$87.30
|
|
|
Service Code
|
CPT 89325
|
| Hospital Charge Code |
900911439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$65.48 |
| Rate for Payer: Adventist Health Commercial |
$17.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.98
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.10
|
| Rate for Payer: Heritage Provider Network Senior |
$59.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.82
|
| Rate for Payer: Multiplan Commercial |
$65.48
|
|
|
HC LAB REF ST LOUIS ENCEPH AB IGM
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.61
|
| Rate for Payer: Heritage Provider Network Senior |
$11.61
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$14.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF ST LOUIS ENCEPH AB IGM
|
Facility
|
IP
|
$18.75
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$14.06
|
|
|
HC LAB REF STREPTOMYCIN LEVEL
|
Facility
|
OP
|
$120.77
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911595
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$24.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.97
|
| 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 |
$54.35
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.50
|
| 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 |
$78.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.76
|
| Rate for Payer: Heritage Provider Network Senior |
$74.76
|
| 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 |
$21.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.19
|
| 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 |
$90.58
|
| 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 STREPTOMYCIN LEVEL
|
Facility
|
IP
|
$120.77
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911595
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$90.58 |
| Rate for Payer: Adventist Health Commercial |
$24.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.97
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.76
|
| Rate for Payer: Heritage Provider Network Senior |
$81.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.19
|
| Rate for Payer: Multiplan Commercial |
$90.58
|
|
|
HC LAB REF STRIATIONAL ABS
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.74
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.55
|
| Rate for Payer: Heritage Provider Network Senior |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
|
|
HC LAB REF STRIATIONAL ABS
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.48
|
| Rate for Payer: Heritage Provider Network Senior |
$11.48
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC LAB REF STRYCHNINE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900911075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$241.01 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.01
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Senior |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.18
|
| Rate for Payer: Heritage Provider Network Senior |
$71.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC LAB REF STRYCHNINE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900911075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC LAB REF SULFHEMOGLOBIN
|
Facility
|
IP
|
$8.62
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900910299
|
|
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 SULFHEMOGLOBIN
|
Facility
|
OP
|
$8.62
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900910299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$69.20 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.20
|
| Rate for Payer: Blue Shield of California Commercial |
$64.62
|
| Rate for Payer: Blue Shield of California EPN |
$50.52
|
| 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 |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.68
|
| Rate for Payer: Dignity Health Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5.34
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.80
|
| Rate for Payer: TriValley Medical Group Senior |
$8.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
HC LAB REF T3 UPTAKE
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900910792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC LAB REF T3 UPTAKE
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900910792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.37
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
|
|
HC LAB REF TALWIN (PENTAZ)
|
Facility
|
IP
|
$82.49
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$61.87 |
| Rate for Payer: Adventist Health Commercial |
$16.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.85
|
| Rate for Payer: Heritage Provider Network Senior |
$55.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$61.87
|
|
|
HC LAB REF TALWIN (PENTAZ)
|
Facility
|
OP
|
$82.49
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$16.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.06
|
| Rate for Payer: Heritage Provider Network Senior |
$51.06
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$61.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF THIOPENTAL (PENTOTHAL)
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
|
|
HC LAB REF THIOPENTAL (PENTOTHAL)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.96
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Senior |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC LAB REF TIAGABINE LEVEL
|
Facility
|
OP
|
$78.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$137.68 |
| Rate for Payer: Adventist Health Commercial |
$15.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.89
|
| Rate for Payer: Blue Shield of California Commercial |
$137.68
|
| Rate for Payer: Blue Shield of California EPN |
$107.63
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.69
|
| Rate for Payer: Heritage Provider Network Senior |
$48.69
|
| Rate for Payer: Humana Medicare |
$27.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$59.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC LAB REF TIAGABINE LEVEL
|
Facility
|
IP
|
$78.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Adventist Health Commercial |
$15.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.25
|
| Rate for Payer: Heritage Provider Network Senior |
$53.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$59.00
|
|
