|
HC LAB REF CHORIONIC VILLUS
|
Facility
IP
|
$257.48
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900912555
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$193.11 |
| Rate for Payer: Adventist Health Commercial |
$51.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$176.89
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.31
|
| Rate for Payer: Heritage Provider Network Senior |
$174.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$193.11
|
|
|
HC LAB REF CHROMOSOMAL IN SITU HYBRIDIZAT
|
Facility
IP
|
$292.62
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912581
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Adventist Health Commercial |
$58.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.03
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.10
|
| Rate for Payer: Heritage Provider Network Senior |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.16
|
| Rate for Payer: Multiplan Commercial |
$219.46
|
|
|
HC LAB REF CHROMOSOMAL IN SITU HYBRIDIZAT
|
Facility
OP
|
$292.62
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912581
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$1,590.45 |
| Rate for Payer: Adventist Health Commercial |
$58.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,590.45
|
| Rate for Payer: Blue Shield of California Commercial |
$250.94
|
| Rate for Payer: Blue Shield of California EPN |
$196.17
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.13
|
| Rate for Payer: Heritage Provider Network Senior |
$181.13
|
| Rate for Payer: Humana Medicare |
$34.81
|
| Rate for Payer: IEHP Medi-Cal |
$44.55
|
| Rate for Payer: IEHP Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.86
|
| Rate for Payer: Multiplan Commercial |
$219.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
CPT 88299
|
| Hospital Charge Code |
900912794
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$128.63 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Blue Shield of California Commercial |
$71.42
|
| Rate for Payer: Blue Shield of California EPN |
$67.50
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: Dignity Health Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.18
|
| Rate for Payer: Heritage Provider Network Senior |
$71.18
|
| Rate for Payer: Humana Medicare |
$67.70
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.30
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.70
|
| Rate for Payer: TriValley Medical Group Senior |
$67.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 88299
|
| Hospital Charge Code |
900912794
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC LAB REF CHROMOSOME IN SITU HYB 10-30 C
|
Facility
IP
|
$46.02
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912795
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$34.52 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.62
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.16
|
| Rate for Payer: Heritage Provider Network Senior |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$34.52
|
|
|
HC LAB REF CHROMOSOME IN SITU HYB 10-30 C
|
Facility
OP
|
$46.02
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912795
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$1,590.45 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,590.45
|
| Rate for Payer: Blue Shield of California Commercial |
$250.94
|
| Rate for Payer: Blue Shield of California EPN |
$196.17
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.49
|
| Rate for Payer: Heritage Provider Network Senior |
$28.49
|
| Rate for Payer: Humana Medicare |
$34.81
|
| Rate for Payer: IEHP Medi-Cal |
$44.55
|
| Rate for Payer: IEHP Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.86
|
| Rate for Payer: Multiplan Commercial |
$34.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC LAB REF CHROMOSOME INTERP & REPORT
|
Facility
IP
|
$334.70
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$251.02 |
| Rate for Payer: Adventist Health Commercial |
$66.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.94
|
| Rate for Payer: Cash Price |
$150.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.59
|
| Rate for Payer: Heritage Provider Network Senior |
$226.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.68
|
| Rate for Payer: Multiplan Commercial |
$251.02
|
|
|
HC LAB REF CHROMOSOME INTERP & REPORT
|
Facility
OP
|
$334.70
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$284.50 |
| Rate for Payer: Adventist Health Commercial |
$66.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$284.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$184.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$251.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$207.85
|
| Rate for Payer: Blue Shield of California EPN |
$196.47
|
| Rate for Payer: Cash Price |
$150.62
|
| Rate for Payer: Cash Price |
$150.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.50
|
| Rate for Payer: Dignity Health Senior |
$284.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.18
|
| Rate for Payer: Heritage Provider Network Senior |
$207.18
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$161.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.68
|
| Rate for Payer: Multiplan Commercial |
$251.02
|
| 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 Medi-Cal |
$284.50
|
| Rate for Payer: Vantage Medical Group Senior |
$284.50
|
|
|
HC LAB REF CHROMOSOMES SCE
|
Facility
OP
|
$505.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$429.49 |
| Rate for Payer: Adventist Health Commercial |
$101.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$347.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$429.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$277.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$378.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$313.78
|
| Rate for Payer: Blue Shield of California EPN |
$296.60
|
| Rate for Payer: Cash Price |
$227.38
|
| Rate for Payer: Cash Price |
$227.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.49
|
| Rate for Payer: Dignity Health Senior |
$429.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.77
|
| Rate for Payer: Heritage Provider Network Senior |
$312.77
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$243.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.32
|
| Rate for Payer: Multiplan Commercial |
$378.96
|
| 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 Medi-Cal |
$429.49
|
| Rate for Payer: Vantage Medical Group Senior |
$429.49
|
|
|
HC LAB REF CHROMOSOMES SCE
|
Facility
IP
|
$505.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$91.46 |
| Max. Negotiated Rate |
$378.96 |
| Rate for Payer: Adventist Health Commercial |
$101.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$347.13
|
| Rate for Payer: Cash Price |
$227.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.07
|
| Rate for Payer: Heritage Provider Network Senior |
$342.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.32
|
| Rate for Payer: Multiplan Commercial |
$378.96
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
OP
|
$100.83
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$20.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.41
|
| Rate for Payer: Heritage Provider Network Senior |
$62.41
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$75.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
IP
|
$100.83
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$75.62 |
| Rate for Payer: Adventist Health Commercial |
$20.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.27
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.26
|
| Rate for Payer: Heritage Provider Network Senior |
$68.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.21
|
| Rate for Payer: Multiplan Commercial |
$75.62
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
IP
|
$178.53
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Adventist Health Commercial |
$35.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.65
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.86
|
| Rate for Payer: Heritage Provider Network Senior |
$120.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.63
|
| Rate for Payer: Multiplan Commercial |
$133.90
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
OP
|
$178.53
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$1,043.23 |
| Rate for Payer: Adventist Health Commercial |
$35.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,043.23
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.51
|
| Rate for Payer: Heritage Provider Network Senior |
$110.51
|
| Rate for Payer: Humana Medicare |
$125.49
|
| Rate for Payer: IEHP Medi-Cal |
$168.18
|
| Rate for Payer: IEHP Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$133.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
IP
|
$238.22
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$178.66 |
| Rate for Payer: Adventist Health Commercial |
$47.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.66
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.27
|
| Rate for Payer: Heritage Provider Network Senior |
$161.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.56
|
| Rate for Payer: Multiplan Commercial |
$178.66
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
OP
|
$238.22
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$1,392.04 |
| Rate for Payer: Adventist Health Commercial |
$47.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$483.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,392.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,015.50
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$154.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Senior |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.46
|
| Rate for Payer: Heritage Provider Network Senior |
$147.46
|
| Rate for Payer: Humana Medicare |
$173.66
|
| Rate for Payer: IEHP Medi-Cal |
$230.63
|
| Rate for Payer: IEHP Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.81
|
| Rate for Payer: Multiplan Commercial |
$178.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$173.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
OP
|
$14.47
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$38.21 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.21
|
| Rate for Payer: Blue Shield of California Commercial |
$35.83
|
| Rate for Payer: Blue Shield of California EPN |
$28.01
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Senior |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.96
|
| Rate for Payer: Heritage Provider Network Senior |
$8.96
|
| Rate for Payer: Humana Medicare |
$13.07
|
| Rate for Payer: IEHP Medi-Cal |
$12.46
|
| Rate for Payer: IEHP Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.47
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.07
|
| Rate for Payer: TriValley Medical Group Senior |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
IP
|
$14.47
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.94
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.80
|
| Rate for Payer: Heritage Provider Network Senior |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
OP
|
$87.16
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.90
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Blue Shield of California EPN |
$81.15
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.95
|
| Rate for Payer: Heritage Provider Network Senior |
$53.95
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: IEHP Medi-Cal |
$19.98
|
| Rate for Payer: IEHP Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$65.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
IP
|
$87.16
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$65.37 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.88
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.01
|
| Rate for Payer: Heritage Provider Network Senior |
$59.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$65.37
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
OP
|
$50.05
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.90
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Blue Shield of California EPN |
$81.15
|
| Rate for Payer: Cash Price |
$22.52
|
| Rate for Payer: Cash Price |
$22.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.98
|
| Rate for Payer: Heritage Provider Network Senior |
$30.98
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: IEHP Medi-Cal |
$19.98
|
| Rate for Payer: IEHP Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
IP
|
$50.05
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Adventist Health Commercial |
$10.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.38
|
| Rate for Payer: Cash Price |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.88
|
| Rate for Payer: Heritage Provider Network Senior |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.51
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.76
|
| Rate for Payer: Blue Shield of California Commercial |
$120.18
|
| Rate for Payer: Blue Shield of California EPN |
$93.96
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Senior |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Humana Medicare |
$15.39
|
| Rate for Payer: IEHP Medi-Cal |
$21.34
|
| Rate for Payer: IEHP Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.39
|
| Rate for Payer: TriValley Medical Group Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
