|
HC LAB REF MMR MUMPS IGG IFA
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC LAB REF MMR MUMPS IGG IFA
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC LAB REF MMR RUBELLA IGG ELISA
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900912871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$130.98 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.98
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC LAB REF MMR RUBELLA IGG ELISA
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900912871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC LAB REF MMR RUBEOLA IGG IFA
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912869
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.88
|
| Rate for Payer: Heritage Provider Network Senior |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
|
|
HC LAB REF MMR RUBEOLA IGG IFA
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912869
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900910683
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC LAB REF MOLECULAR CYTOGENETICS,DNA PRO
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900910683
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.02
|
| Rate for Payer: Heritage Provider Network Senior |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
|
|
HC LAB REF MOLECULAR CYTOGENTCS 100-300CE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900910679
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$2,389.68 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,389.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC LAB REF MOLECULAR CYTOGENTCS 100-300CE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900910679
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC LAB REF MORPHOMETRIC ANALYSIS IN SITU
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
900912796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.42
|
| Rate for Payer: Heritage Provider Network Senior |
$49.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
|
|
HC LAB REF MORPHOMETRIC ANALYSIS IN SITU
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
900912796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$785.87 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.87
|
| Rate for Payer: Blue Shield of California Commercial |
$594.43
|
| Rate for Payer: Blue Shield of California EPN |
$478.02
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| 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 |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC LAB REF MS PANEL IGG CSF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| 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 |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| 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 |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| 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 |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| 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 |
$11.25
|
| 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 MS PANEL IGG CSF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC LAB REF MS PANEL IGG, SERUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900912659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC LAB REF MS PANEL IGG, SERUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900912659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| 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 |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| 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 |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| 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 |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| 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 |
$11.25
|
| 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 MTHFR MUTATION
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900912713
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$417.40 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.40
|
| Rate for Payer: Blue Shield of California Commercial |
$38.43
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.87
|
| Rate for Payer: Dignity Health Senior |
$65.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.33
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.34
|
| Rate for Payer: TriValley Medical Group Senior |
$65.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Vantage Medical Group Senior |
$65.34
|
|
|
HC LAB REF MTHFR MUTATION
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900912713
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
|
|
HC LAB REF MUMPS AB IGG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900910544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC LAB REF MUMPS AB IGG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900910544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.22
|
| Rate for Payer: Heritage Provider Network Senior |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
|
|
HC LAB REF MUMPS AB IGM
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912693
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.22
|
| Rate for Payer: Heritage Provider Network Senior |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
|
|
HC LAB REF MUMPS AB IGM
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912693
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC LAB REF MYOCARDIAL AB IFA
|
Facility
|
OP
|
$38.15
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900911390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.21
|
| 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 |
$20.98
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.80
|
| 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 |
$24.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.61
|
| Rate for Payer: Heritage Provider Network Senior |
$23.61
|
| 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 |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| 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 |
$28.61
|
| 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 MYOCARDIAL AB IFA
|
Facility
|
IP
|
$38.15
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900911390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$28.61 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.83
|
| Rate for Payer: Heritage Provider Network Senior |
$25.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: Multiplan Commercial |
$28.61
|
|
|
HC LAB REF NEISSERIA GONORRHOEAE AB
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
900911592
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
