|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$43.47
|
| Rate for Payer: Blue Shield of California EPN |
$41.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Senior |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
IP
|
$565.88
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.42 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Adventist Health Commercial |
$113.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.76
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.10
|
| Rate for Payer: Heritage Provider Network Senior |
$383.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.47
|
| Rate for Payer: Multiplan Commercial |
$424.41
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
OP
|
$565.88
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Adventist Health Commercial |
$113.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$481.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$424.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$351.41
|
| Rate for Payer: Blue Shield of California EPN |
$332.17
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cash Price |
$254.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.00
|
| Rate for Payer: Dignity Health Senior |
$481.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.28
|
| Rate for Payer: Heritage Provider Network Senior |
$350.28
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$272.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.47
|
| Rate for Payer: Multiplan Commercial |
$424.41
|
| 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 |
$481.00
|
| Rate for Payer: Vantage Medical Group Senior |
$481.00
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
OP
|
$430.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$365.74 |
| Rate for Payer: Adventist Health Commercial |
$86.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$365.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$236.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$322.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$267.20
|
| Rate for Payer: Blue Shield of California EPN |
$252.57
|
| Rate for Payer: Cash Price |
$193.63
|
| Rate for Payer: Cash Price |
$193.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$279.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.74
|
| Rate for Payer: Dignity Health Senior |
$365.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.34
|
| Rate for Payer: Heritage Provider Network Senior |
$266.34
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.57
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| 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 |
$365.74
|
| Rate for Payer: Vantage Medical Group Senior |
$365.74
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
IP
|
$430.28
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$322.71 |
| Rate for Payer: Adventist Health Commercial |
$86.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.60
|
| Rate for Payer: Cash Price |
$193.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.30
|
| Rate for Payer: Heritage Provider Network Senior |
$291.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.57
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
OP
|
$262.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$223.12 |
| Rate for Payer: Adventist Health Commercial |
$52.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$223.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$144.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$163.01
|
| Rate for Payer: Blue Shield of California EPN |
$154.09
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.12
|
| Rate for Payer: Dignity Health Senior |
$223.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.49
|
| Rate for Payer: Heritage Provider Network Senior |
$162.49
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.62
|
| Rate for Payer: Multiplan Commercial |
$196.88
|
| 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 |
$223.12
|
| Rate for Payer: Vantage Medical Group Senior |
$223.12
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
IP
|
$262.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.51 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Adventist Health Commercial |
$52.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.34
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.71
|
| Rate for Payer: Heritage Provider Network Senior |
$177.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.62
|
| Rate for Payer: Multiplan Commercial |
$196.88
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
IP
|
$6.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
OP
|
$6.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.02
|
| Rate for Payer: Heritage Provider Network Senior |
$4.02
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
| 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 |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.52
|
|
|
HC LAB REF GAMMA GLOBULIN SUBCLASS
|
Facility
OP
|
$19.47
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$278.82 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.82
|
| Rate for Payer: Blue Shield of California Commercial |
$62.61
|
| Rate for Payer: Blue Shield of California EPN |
$48.94
|
| Rate for Payer: Cash Price |
$8.76
|
| Rate for Payer: Cash Price |
$8.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Senior |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Humana Medicare |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$11.12
|
| Rate for Payer: IEHP Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.11
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC LAB REF GAMMA GLOBULIN SUBCLASS
|
Facility
IP
|
$19.47
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.38
|
| Rate for Payer: Cash Price |
$8.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.18
|
| Rate for Payer: Heritage Provider Network Senior |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
|
|
HC LAB REF GREEN COFFEE BEAN IGE
|
Facility
IP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912523
|
|
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 GREEN COFFEE BEAN IGE
|
Facility
OP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912523
|
|
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 HEAVY METALS UR ARSENIC
|
Facility
IP
|
$19.85
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900912663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.64
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.44
|
| Rate for Payer: Heritage Provider Network Senior |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
|
|
HC LAB REF HEAVY METALS UR ARSENIC
|
Facility
OP
|
$19.85
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900912663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$158.80 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.80
|
| Rate for Payer: Blue Shield of California Commercial |
$148.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.85
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Senior |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.29
|
| Rate for Payer: Heritage Provider Network Senior |
$12.29
|
| Rate for Payer: Humana Medicare |
$18.97
|
| Rate for Payer: IEHP Medi-Cal |
$26.30
|
| Rate for Payer: IEHP Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.90
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.97
|
| Rate for Payer: TriValley Medical Group Senior |
$18.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC LAB REF HEAVY METALS UR CADMIUM
|
Facility
OP
|
$24.21
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900912662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$193.62 |
| Rate for Payer: Adventist Health Commercial |
$4.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.62
|
| Rate for Payer: Blue Shield of California Commercial |
$180.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.28
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Senior |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.99
|
| Rate for Payer: Heritage Provider Network Senior |
$14.99
|
| Rate for Payer: Humana Medicare |
$23.64
|
| Rate for Payer: IEHP Medi-Cal |
$32.09
|
| Rate for Payer: IEHP Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$18.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.64
|
| Rate for Payer: TriValley Medical Group Senior |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC LAB REF HEAVY METALS UR CADMIUM
|
Facility
IP
|
$24.21
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900912662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Adventist Health Commercial |
$4.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.63
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.39
|
| Rate for Payer: Heritage Provider Network Senior |
$16.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$18.16
|
|
|
HC LAB REF HEAVY METALS UR LEAD
|
Facility
IP
|
$12.67
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900912661
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.58
|
| Rate for Payer: Heritage Provider Network Senior |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
|
|
HC LAB REF HEAVY METALS UR LEAD
|
Facility
OP
|
$12.67
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900912661
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$101.32 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.32
|
| Rate for Payer: Blue Shield of California Commercial |
$94.53
|
| Rate for Payer: Blue Shield of California EPN |
$73.90
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.84
|
| Rate for Payer: Heritage Provider Network Senior |
$7.84
|
| Rate for Payer: Humana Medicare |
$12.11
|
| Rate for Payer: IEHP Medi-Cal |
$16.58
|
| Rate for Payer: IEHP Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC LAB REF HEAVY METALS UR MERCURY
|
Facility
IP
|
$17.01
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900912664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.69
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.52
|
| Rate for Payer: Heritage Provider Network Senior |
$11.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.76
|
|
|
HC LAB REF HEAVY METALS UR MERCURY
|
Facility
OP
|
$17.01
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900912664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.47
|
| Rate for Payer: Blue Shield of California Commercial |
$127.00
|
| Rate for Payer: Blue Shield of California EPN |
$99.29
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Senior |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.53
|
| Rate for Payer: Heritage Provider Network Senior |
$10.53
|
| Rate for Payer: Humana Medicare |
$16.26
|
| Rate for Payer: IEHP Medi-Cal |
$22.03
|
| Rate for Payer: IEHP Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.26
|
| Rate for Payer: TriValley Medical Group Senior |
$16.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC LAB REF HEPATITIS BS AB QUANT
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900910964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$61.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
|
|
HC LAB REF HEPATITIS BS AB QUANT
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900910964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.49
|
| Rate for Payer: Blue Shield of California Commercial |
$117.11
|
| Rate for Payer: Blue Shield of California EPN |
$91.55
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.33
|
| Rate for Payer: Heritage Provider Network Senior |
$56.33
|
| Rate for Payer: Humana Medicare |
$14.99
|
| Rate for Payer: IEHP Medi-Cal |
$16.36
|
| Rate for Payer: IEHP Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.89
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC LAB REF HERPESVIRUS 6 AB IGG
|
Facility
IP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900910749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.76
|
| Rate for Payer: Heritage Provider Network Senior |
$33.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
|
