|
HC LAB REF PROTRIPTYLINE (VIVACTYL)
|
Facility
IP
|
$52.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$39.74 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.40
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.87
|
| Rate for Payer: Heritage Provider Network Senior |
$35.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.74
|
|
|
HC LAB REF QUINIDINE
|
Facility
IP
|
$59.40
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
900910456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: Adventist Health Commercial |
$11.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.81
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.21
|
| Rate for Payer: Heritage Provider Network Senior |
$40.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.85
|
| Rate for Payer: Multiplan Commercial |
$44.55
|
|
|
HC LAB REF QUINIDINE
|
Facility
OP
|
$59.40
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
900910456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$122.17 |
| Rate for Payer: Adventist Health Commercial |
$11.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.17
|
| Rate for Payer: Blue Shield of California Commercial |
$113.98
|
| Rate for Payer: Blue Shield of California EPN |
$89.10
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Senior |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: IEHP Medi-Cal |
$20.25
|
| Rate for Payer: IEHP Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$44.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Senior |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC LAB REF RAJI CELL
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC LAB REF RAJI CELL
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$203.99 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.99
|
| Rate for Payer: Blue Shield of California Commercial |
$190.34
|
| Rate for Payer: Blue Shield of California EPN |
$148.80
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$24.37
|
| Rate for Payer: IEHP Medi-Cal |
$33.79
|
| Rate for Payer: IEHP Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF RENIN ACT PLASMA
|
Facility
IP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.43
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
|
|
HC LAB REF RENIN ACT PLASMA
|
Facility
OP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$184.10 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.10
|
| Rate for Payer: Blue Shield of California Commercial |
$171.78
|
| Rate for Payer: Blue Shield of California EPN |
$134.29
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.19
|
| Rate for Payer: Dignity Health Senior |
$21.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.49
|
| Rate for Payer: Heritage Provider Network Senior |
$8.49
|
| Rate for Payer: Humana Medicare |
$21.99
|
| Rate for Payer: IEHP Medi-Cal |
$30.50
|
| Rate for Payer: IEHP Medicare Advantage |
$21.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.99
|
| Rate for Payer: TriValley Medical Group Senior |
$21.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.99
|
|
|
HC LAB REF REPTILASE TIME
|
Facility
IP
|
$14.10
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.69
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.55
|
| Rate for Payer: Heritage Provider Network Senior |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.52
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
|
|
HC LAB REF REPTILASE TIME
|
Facility
OP
|
$14.10
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$82.44 |
| Rate for Payer: Adventist Health Commercial |
$2.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.44
|
| Rate for Payer: Blue Shield of California Commercial |
$76.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.13
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.84
|
| Rate for Payer: Dignity Health Senior |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.73
|
| Rate for Payer: Heritage Provider Network Senior |
$8.73
|
| Rate for Payer: Humana Medicare |
$9.85
|
| Rate for Payer: IEHP Medi-Cal |
$13.65
|
| Rate for Payer: IEHP Medicare Advantage |
$9.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.41
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.85
|
| Rate for Payer: TriValley Medical Group Senior |
$9.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
HC LAB REF RETICULIN AB
|
Facility
IP
|
$12.16
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.35
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Senior |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
|
|
HC LAB REF RETICULIN AB
|
Facility
OP
|
$12.16
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7.53
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$13.46
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC LAB REF RIFAMPIN
|
Facility
OP
|
$122.26
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$24.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.68
|
| Rate for Payer: Heritage Provider Network Senior |
$75.68
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$91.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC LAB REF RIFAMPIN
|
Facility
IP
|
$122.26
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Adventist Health Commercial |
$24.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.99
|
| Rate for Payer: Cash Price |
$55.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.77
|
| Rate for Payer: Heritage Provider Network Senior |
$82.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.56
|
| Rate for Payer: Multiplan Commercial |
$91.70
|
|
|
HC LAB REF RISPERIDONE
|
Facility
IP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$64.47 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.05
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.49
|
| Rate for Payer: Multiplan Commercial |
$64.47
|
|
|
HC LAB REF RISPERIDONE
|
Facility
OP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.04
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.07
|
| Rate for Payer: Dignity Health Senior |
$73.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.21
|
| Rate for Payer: Heritage Provider Network Senior |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.49
|
| Rate for Payer: Multiplan Commercial |
$64.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.07
|
| Rate for Payer: Vantage Medical Group Senior |
$73.07
|
|
|
HC LAB REF SALMONELLA SEROTYPING
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC LAB REF SALMONELLA SEROTYPING
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Senior |
$87.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$5.66
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC LAB REF SCRUB TYPHUS
|
Facility
IP
|
$127.20
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
900912586
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$25.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.39
|
| Rate for Payer: Cash Price |
$57.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.11
|
| Rate for Payer: Heritage Provider Network Senior |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
|
|
HC LAB REF SCRUB TYPHUS
|
Facility
OP
|
$127.20
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
900912586
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$161.90 |
| Rate for Payer: Adventist Health Commercial |
$25.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.90
|
| Rate for Payer: Blue Shield of California Commercial |
$151.21
|
| Rate for Payer: Blue Shield of California EPN |
$118.21
|
| Rate for Payer: Cash Price |
$57.24
|
| Rate for Payer: Cash Price |
$57.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.74
|
| Rate for Payer: Heritage Provider Network Senior |
$78.74
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: IEHP Medi-Cal |
$26.83
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF SPERM IGG AB
|
Facility
IP
|
$87.30
|
|
|
Service Code
|
CPT 89325
|
| Hospital Charge Code |
900911439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$65.48 |
| Rate for Payer: Adventist Health Commercial |
$17.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.98
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.10
|
| Rate for Payer: Heritage Provider Network Senior |
$59.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.82
|
| Rate for Payer: Multiplan Commercial |
$65.48
|
|
|
HC LAB REF SPERM IGG AB
|
Facility
OP
|
$87.30
|
|
|
Service Code
|
CPT 89325
|
| Hospital Charge Code |
900911439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$89.32 |
| Rate for Payer: Adventist Health Commercial |
$17.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.32
|
| Rate for Payer: Blue Shield of California Commercial |
$83.35
|
| Rate for Payer: Blue Shield of California EPN |
$65.16
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.74
|
| Rate for Payer: Dignity Health Senior |
$10.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.04
|
| Rate for Payer: Heritage Provider Network Senior |
$54.04
|
| Rate for Payer: Humana Medicare |
$10.67
|
| Rate for Payer: IEHP Medicare Advantage |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$65.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.67
|
| Rate for Payer: TriValley Medical Group Senior |
$10.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.67
|
|
|
HC LAB REF ST LOUIS ENCEPH AB IGM
|
Facility
OP
|
$18.75
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912652
|
|
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 ST LOUIS ENCEPH AB IGM
|
Facility
IP
|
$18.75
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912652
|
|
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 STREPTOMYCIN LEVEL
|
Facility
IP
|
$120.77
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911595
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$90.58 |
| Rate for Payer: Adventist Health Commercial |
$24.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.97
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.76
|
| Rate for Payer: Heritage Provider Network Senior |
$81.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.19
|
| Rate for Payer: Multiplan Commercial |
$90.58
|
|
|
HC LAB REF STREPTOMYCIN LEVEL
|
Facility
OP
|
$120.77
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911595
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$24.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.76
|
| Rate for Payer: Heritage Provider Network Senior |
$74.76
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$90.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
