|
HC IMMUNOFLUORESCENCE STAIN EA AB
|
Facility
OP
|
$178.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
903800037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.17
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$104.49
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$87.44
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC IMMUNOFLUORESCENCE STAIN EA AB
|
Facility
IP
|
$649.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
903800037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.47 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.86
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.37
|
| Rate for Payer: Heritage Provider Network Senior |
$439.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.25
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
|
|
HC IMMUNOFLUORES STAIN EA ADDL
|
Facility
IP
|
$812.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
903800289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC IMMUNOFLUORES STAIN EA ADDL
|
Facility
OP
|
$178.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
903800289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$464.50
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$104.49
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Senior |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: IEHP Medi-Cal |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$137.83 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.83
|
| Rate for Payer: Blue Shield of California Commercial |
$128.63
|
| Rate for Payer: Blue Shield of California EPN |
$100.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Senior |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$16.46
|
| Rate for Payer: IEHP Medi-Cal |
$22.78
|
| Rate for Payer: IEHP Medicare Advantage |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.46
|
| Rate for Payer: TriValley Medical Group Senior |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.53
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.53
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
OP
|
$178.30
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$35.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$139.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.79
|
| Rate for Payer: Blue Shield of California Commercial |
$110.72
|
| Rate for Payer: Blue Shield of California EPN |
$104.66
|
| Rate for Payer: Cash Price |
$80.24
|
| Rate for Payer: Cash Price |
$80.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.37
|
| Rate for Payer: Heritage Provider Network Senior |
$110.37
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$83.91
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$133.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
IP
|
$649.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.47 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.86
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.37
|
| Rate for Payer: Heritage Provider Network Senior |
$439.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.25
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
IP
|
$740.19
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.97 |
| Max. Negotiated Rate |
$555.14 |
| Rate for Payer: Adventist Health Commercial |
$148.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.51
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.11
|
| Rate for Payer: Heritage Provider Network Senior |
$501.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.05
|
| Rate for Payer: Multiplan Commercial |
$555.14
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
OP
|
$740.19
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$629.16 |
| Rate for Payer: Adventist Health Commercial |
$148.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$629.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$555.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.75
|
| Rate for Payer: Blue Shield of California Commercial |
$459.66
|
| Rate for Payer: Blue Shield of California EPN |
$434.49
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.16
|
| Rate for Payer: Dignity Health Senior |
$629.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.18
|
| Rate for Payer: Heritage Provider Network Senior |
$458.18
|
| Rate for Payer: IEHP Medi-Cal |
$94.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$356.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.05
|
| Rate for Payer: Multiplan Commercial |
$555.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.16
|
| Rate for Payer: Vantage Medical Group Senior |
$629.16
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.85
|
| Rate for Payer: Blue Shield of California Commercial |
$103.71
|
| Rate for Payer: Blue Shield of California EPN |
$98.03
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$88.51
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
IP
|
$974.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$730.50 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$669.14
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$659.40
|
| Rate for Payer: Heritage Provider Network Senior |
$659.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.50
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$186.97 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.97
|
| Rate for Payer: Blue Shield of California Commercial |
$174.46
|
| Rate for Payer: Blue Shield of California EPN |
$136.39
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Senior |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Humana Medicare |
$22.34
|
| Rate for Payer: IEHP Medi-Cal |
$30.98
|
| Rate for Payer: IEHP Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.15
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.64
|
| Rate for Payer: Heritage Provider Network Senior |
$172.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
OP
|
$27,338.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.14 |
| Max. Negotiated Rate |
$23,237.30 |
| Rate for Payer: Adventist Health Commercial |
$5,467.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,781.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,237.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,035.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20,503.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,769.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,237.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,237.30
|
| Rate for Payer: Dignity Health Senior |
$23,237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,922.22
|
| Rate for Payer: Heritage Provider Network Senior |
$16,922.22
|
| Rate for Payer: IEHP Medi-Cal |
$159.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,176.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,834.50
|
| Rate for Payer: Multiplan Commercial |
$20,503.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,237.30
|
| Rate for Payer: Vantage Medical Group Senior |
$23,237.30
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
IP
|
$27,338.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,948.18 |
| Max. Negotiated Rate |
$20,503.50 |
| Rate for Payer: Adventist Health Commercial |
$5,467.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,781.21
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,507.83
|
| Rate for Payer: Heritage Provider Network Senior |
$18,507.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,834.50
|
| Rate for Payer: Multiplan Commercial |
$20,503.50
|
|
|
HC IMPL AGA DUCT OCCL DEVICE
|
Facility
IP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,475.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,837.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,247.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,160.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,723.22
|
| Rate for Payer: Heritage Provider Network Senior |
$7,723.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,704.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,704.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,704.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.00
|
| Rate for Payer: Multiplan Commercial |
$8,556.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,159.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,811.41
|
|
|
HC IMPL AGA DUCT OCCL DEVICE
|
Facility
OP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,475.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,837.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,274.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,556.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,084.37
|
| Rate for Payer: Blue Shield of California EPN |
$6,696.50
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,247.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,696.80
|
| Rate for Payer: Dignity Health Senior |
$9,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,301.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,281.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5,281.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,704.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,704.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,704.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.00
|
| Rate for Payer: Multiplan Commercial |
$8,556.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,159.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,811.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,696.80
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
|
