|
HC LAB REF HSV 1/2 IGM CSF
|
Facility
|
OP
|
$119.00
|
|
| Hospital Charge Code |
900911351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.25
|
| Rate for Payer: Blue Shield of California Commercial |
$72.59
|
| Rate for Payer: Blue Shield of California EPN |
$58.07
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.15
|
| Rate for Payer: Dignity Health Senior |
$101.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.30
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.15
|
| Rate for Payer: Vantage Medical Group Senior |
$101.15
|
|
|
HC LAB REF HSV 1/2 IGM CSF
|
Facility
|
IP
|
$119.00
|
|
| Hospital Charge Code |
900911351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC LAB REF HSV 1 IGG
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900911468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| 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 |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| 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 |
$12.00
|
| 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 |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF HSV 1 IGG
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900911468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
|
|
HC LAB REF HSV 2 IGG
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900911469
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.58
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| 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 |
$12.00
|
| 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 |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF HSV 2 IGG
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900911469
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
|
|
HC LAB REF HSV PCR
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900910770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| 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 LAB REF HSV PCR
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900910770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF IGF-BP2
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.36
|
| Rate for Payer: Heritage Provider Network Senior |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
|
|
HC LAB REF IGF-BP2
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$123.36 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C1Q
|
Facility
|
IP
|
$72.18
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912836
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$54.13 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$54.13
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C1Q
|
Facility
|
OP
|
$72.18
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912836
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.50
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$54.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C3D
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.84
|
| Rate for Payer: Heritage Provider Network Senior |
$54.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C3D
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.50
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.14
|
| Rate for Payer: Heritage Provider Network Senior |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL PEG
|
Facility
|
OP
|
$72.19
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911375
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.50
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.69
|
| Rate for Payer: Heritage Provider Network Senior |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$54.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL PEG
|
Facility
|
IP
|
$72.19
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911375
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$54.14 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$54.14
|
|
|
HC LAB REF IMMUNO FIXATION ELECTROPHORESI
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900912722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$203.93 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.93
|
| Rate for Payer: Blue Shield of California Commercial |
$179.77
|
| Rate for Payer: Blue Shield of California EPN |
$144.19
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.35
|
| 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 |
$116.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.80
|
| Rate for Payer: Heritage Provider Network Senior |
$110.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| 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 |
$134.25
|
| 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 LAB REF IMMUNO FIXATION ELECTROPHORESI
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900912722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC LAB REF IMMUNO FIXATION ELECTRO UR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.82
|
| Rate for Payer: Heritage Provider Network Senior |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
|
|
HC LAB REF IMMUNO FIXATION ELECTRO UR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.04
|
| Rate for Payer: Blue Shield of California Commercial |
$236.16
|
| Rate for Payer: Blue Shield of California EPN |
$189.42
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Senior |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.09
|
| Rate for Payer: Heritage Provider Network Senior |
$29.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.35
|
| Rate for Payer: TriValley Medical Group Senior |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC LAB REF IMMUNOGLOBULINS IGA SALIVARY
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900911376
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC LAB REF IMMUNOGLOBULINS IGA SALIVARY
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900911376
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.74
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| 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 |
$64.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| 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 |
$74.25
|
| 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 LAB REF INFLUENZA A AB IGM
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.51
|
| Rate for Payer: Heritage Provider Network Senior |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
|
|
HC LAB REF INFLUENZA A AB IGM
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$126.12 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC LAB REF INFLUENZA B AB IGM
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.42
|
| Rate for Payer: Heritage Provider Network Senior |
$5.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
|
