|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
OP
|
$22.04
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.14
|
| 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 |
$9.92
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.33
|
| 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 |
$14.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.64
|
| Rate for Payer: Heritage Provider Network Senior |
$13.64
|
| 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 |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| 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 |
$16.53
|
| 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
|
|
|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
IP
|
$22.04
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.14
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
|
|
HC LAB REF CYCLIC AMP URINE
|
Facility
OP
|
$36.95
|
|
|
Service Code
|
CPT 82030
|
| Hospital Charge Code |
900911047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$215.88 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.88
|
| Rate for Payer: Blue Shield of California Commercial |
$201.52
|
| Rate for Payer: Blue Shield of California EPN |
$157.54
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.38
|
| Rate for Payer: Dignity Health Senior |
$25.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.87
|
| Rate for Payer: Heritage Provider Network Senior |
$22.87
|
| Rate for Payer: Humana Medicare |
$25.80
|
| Rate for Payer: IEHP Medi-Cal |
$35.77
|
| Rate for Payer: IEHP Medicare Advantage |
$25.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.51
|
| Rate for Payer: Multiplan Commercial |
$27.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.38
|
| Rate for Payer: Vantage Medical Group Senior |
$25.80
|
|
|
HC LAB REF CYCLIC AMP URINE
|
Facility
IP
|
$36.95
|
|
|
Service Code
|
CPT 82030
|
| Hospital Charge Code |
900911047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$27.71 |
| Rate for Payer: Adventist Health Commercial |
$7.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.38
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.02
|
| Rate for Payer: Heritage Provider Network Senior |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$27.71
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
IP
|
$125.55
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.25
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.00
|
| Rate for Payer: Heritage Provider Network Senior |
$85.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
OP
|
$125.55
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$69.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$94.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.70
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.72
|
| Rate for Payer: Dignity Health Senior |
$106.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.72
|
| Rate for Payer: Heritage Provider Network Senior |
$77.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.72
|
| Rate for Payer: Vantage Medical Group Senior |
$106.72
|
|
|
HC LAB REF DNA PROBE
|
Facility
IP
|
$30.68
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912580
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.77
|
| Rate for Payer: Heritage Provider Network Senior |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
|
|
HC LAB REF DNA PROBE
|
Facility
OP
|
$30.68
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912580
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Adventist Health Commercial |
$6.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.84
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Senior |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.99
|
| Rate for Payer: Heritage Provider Network Senior |
$18.99
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: IEHP Medi-Cal |
$5.52
|
| Rate for Payer: IEHP Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$23.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC LAB REF DOT/SLOT BLOT NA EA
|
Facility
OP
|
$5.74
|
|
|
Service Code
|
CPT 83893
|
| Hospital Charge Code |
900912785
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC LAB REF DOT/SLOT BLOT NA EA
|
Facility
IP
|
$5.74
|
|
|
Service Code
|
CPT 83893
|
| Hospital Charge Code |
900912785
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
|
|
HC LAB REF EASTERN EQUINE AB IGG
|
Facility
IP
|
$18.75
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900911467
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$14.06
|
|
|
HC LAB REF EASTERN EQUINE AB IGG
|
Facility
OP
|
$18.75
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900911467
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.61
|
| Rate for Payer: Heritage Provider Network Senior |
$11.61
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| 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 |
$14.06
|
| 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 |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF EASTERN EQUINE AB IGM
|
Facility
IP
|
$18.75
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900912653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$14.06
|
|
|
HC LAB REF EASTERN EQUINE AB IGM
|
Facility
OP
|
$18.75
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900912653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.61
|
| Rate for Payer: Heritage Provider Network Senior |
$11.61
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| 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 |
$14.06
|
| 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 |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF ECHINOCOCCUS IGE
|
Facility
IP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
|
|
HC LAB REF ECHINOCOCCUS IGE
|
Facility
OP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.37
|
| Rate for Payer: Heritage Provider Network Senior |
$7.37
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A10
|
Facility
IP
|
$18.13
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911761
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.27
|
| Rate for Payer: Heritage Provider Network Senior |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A10
|
Facility
OP
|
$18.13
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911761
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.22
|
| Rate for Payer: Heritage Provider Network Senior |
$11.22
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: IEHP Medi-Cal |
$18.06
|
| Rate for Payer: IEHP Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A16
|
Facility
OP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912732
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: IEHP Medi-Cal |
$18.06
|
| Rate for Payer: IEHP Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A16
|
Facility
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912732
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A2
|
Facility
OP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: IEHP Medi-Cal |
$18.06
|
| Rate for Payer: IEHP Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A2
|
Facility
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A4
|
Facility
OP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.74
|
| Rate for Payer: Blue Shield of California EPN |
$79.53
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Senior |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.23
|
| Rate for Payer: Heritage Provider Network Senior |
$11.23
|
| Rate for Payer: Humana Medicare |
$13.03
|
| Rate for Payer: IEHP Medi-Cal |
$18.06
|
| Rate for Payer: IEHP Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A4
|
Facility
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A7
|
Facility
IP
|
$18.14
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912729
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.46
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.28
|
| Rate for Payer: Heritage Provider Network Senior |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
|
