|
HC LAB REF ENTEROVIRUS AB POLIO 1
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 1
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 2
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912741
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 2
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912741
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.86
|
| Rate for Payer: Heritage Provider Network Senior |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| 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 |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| 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 |
$14.25
|
| 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 |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC LAB REF FIBRONECTIN IGA
|
Facility
|
OP
|
$168.65
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| 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 |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.39
|
| Rate for Payer: Heritage Provider Network Senior |
$104.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.16
|
| 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 |
$126.49
|
| 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 |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC LAB REF FIBRONECTIN IGA
|
Facility
|
IP
|
$168.65
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.18
|
| Rate for Payer: Heritage Provider Network Senior |
$114.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.16
|
| Rate for Payer: Multiplan Commercial |
$126.49
|
|
|
HC LAB REF FISH ANEUPLOIDY REFLEX, POC
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912706
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Senior |
$26.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
|
|
HC LAB REF FISH ANEUPLOIDY REFLEX, POC
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912706
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Senior |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$186.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Senior |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.65
|
| Rate for Payer: Heritage Provider Network Senior |
$177.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$136.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.95 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.30
|
| Rate for Payer: Heritage Provider Network Senior |
$194.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$164.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$230.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$199.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.95
|
| Rate for Payer: Dignity Health Senior |
$260.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.03
|
| Rate for Payer: Heritage Provider Network Senior |
$190.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$146.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$230.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.95
|
| Rate for Payer: Vantage Medical Group Senior |
$260.95
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.57 |
| Max. Negotiated Rate |
$230.25 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.84
|
| Rate for Payer: Heritage Provider Network Senior |
$207.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.75
|
| Rate for Payer: Multiplan Commercial |
$230.25
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Senior |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Senior |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC LAB REF FLUCONAZOLE LEVEL
|
Facility
|
IP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$14.71 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$14.71
|
|
|
HC LAB REF FLUCONAZOLE LEVEL
|
Facility
|
OP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$3.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.47
|
| 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 |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.75
|
| 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 |
$12.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| 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 |
$14.71
|
| 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 GAMMA GLOBULIN SUBCLASS
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$304.12 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.12
|
| Rate for Payer: Blue Shield of California Commercial |
$64.51
|
| Rate for Payer: Blue Shield of California EPN |
$51.74
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Senior |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.11
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
