|
HC LAB REF STRIATIONAL ABS
|
Facility
OP
|
$18.54
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.48
|
| Rate for Payer: Heritage Provider Network Senior |
$11.48
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC LAB REF STRIATIONAL ABS
|
Facility
IP
|
$18.54
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.74
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.55
|
| Rate for Payer: Heritage Provider Network Senior |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
|
|
HC LAB REF STRYCHNINE
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900911075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$241.01 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.01
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Senior |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.18
|
| Rate for Payer: Heritage Provider Network Senior |
$71.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC LAB REF STRYCHNINE
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900911075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC LAB REF SULFHEMOGLOBIN
|
Facility
OP
|
$8.62
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900910299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$69.20 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.20
|
| Rate for Payer: Blue Shield of California Commercial |
$64.62
|
| Rate for Payer: Blue Shield of California EPN |
$50.52
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.68
|
| Rate for Payer: Dignity Health Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5.34
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: IEHP Medi-Cal |
$11.47
|
| Rate for Payer: IEHP Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.80
|
| Rate for Payer: TriValley Medical Group Senior |
$8.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
HC LAB REF SULFHEMOGLOBIN
|
Facility
IP
|
$8.62
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900910299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.92
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.84
|
| Rate for Payer: Heritage Provider Network Senior |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
|
|
HC LAB REF T3 UPTAKE
|
Facility
OP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900910792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC LAB REF T3 UPTAKE
|
Facility
IP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900910792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.37
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
|
|
HC LAB REF TALWIN (PENTAZ)
|
Facility
IP
|
$82.49
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$61.87 |
| Rate for Payer: Adventist Health Commercial |
$16.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.85
|
| Rate for Payer: Heritage Provider Network Senior |
$55.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$61.87
|
|
|
HC LAB REF TALWIN (PENTAZ)
|
Facility
OP
|
$82.49
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911096
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$16.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.06
|
| Rate for Payer: Heritage Provider Network Senior |
$51.06
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$61.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF THIOPENTAL (PENTOTHAL)
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
|
|
HC LAB REF THIOPENTAL (PENTOTHAL)
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.96
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Senior |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC LAB REF TIAGABINE LEVEL
|
Facility
IP
|
$78.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Adventist Health Commercial |
$15.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.25
|
| Rate for Payer: Heritage Provider Network Senior |
$53.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$59.00
|
|
|
HC LAB REF TIAGABINE LEVEL
|
Facility
OP
|
$78.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
900912716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$137.68 |
| Rate for Payer: Adventist Health Commercial |
$15.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.89
|
| Rate for Payer: Blue Shield of California Commercial |
$137.68
|
| Rate for Payer: Blue Shield of California EPN |
$107.63
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.69
|
| Rate for Payer: Heritage Provider Network Senior |
$48.69
|
| Rate for Payer: Humana Medicare |
$27.11
|
| Rate for Payer: IEHP Medi-Cal |
$30.67
|
| Rate for Payer: IEHP Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$59.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC LAB REF TISSUE CULT OTHER SOLID TISSUE
|
Facility
OP
|
$67.01
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910776
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$156.37 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$41.61
|
| Rate for Payer: Blue Shield of California EPN |
$39.33
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.96
|
| Rate for Payer: Dignity Health Senior |
$56.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.48
|
| Rate for Payer: Heritage Provider Network Senior |
$41.48
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Multiplan Commercial |
$50.26
|
| 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 |
$56.96
|
| Rate for Payer: Vantage Medical Group Senior |
$56.96
|
|
|
HC LAB REF TISSUE CULT OTHER SOLID TISSUE
|
Facility
IP
|
$67.01
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910776
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$50.26 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.04
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.37
|
| Rate for Payer: Heritage Provider Network Senior |
$45.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Multiplan Commercial |
$50.26
|
|
|
HC LAB REF TISSUE CULTURE LYMPHOCYTE NON
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900910686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC LAB REF TISSUE CULTURE LYMPHOCYTE NON
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900910686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$909.88 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.85
|
| Rate for Payer: Blue Shield of California Commercial |
$909.88
|
| Rate for Payer: Blue Shield of California EPN |
$711.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Humana Medicare |
$116.49
|
| Rate for Payer: IEHP Medi-Cal |
$157.53
|
| Rate for Payer: IEHP Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$221.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.78
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC LAB REF TISSUE CULTURE NEO BLOOD/BONE
|
Facility
OP
|
$180.91
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900912791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$986.47 |
| Rate for Payer: Adventist Health Commercial |
$36.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$367.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$897.50
|
| Rate for Payer: Blue Shield of California Commercial |
$986.47
|
| Rate for Payer: Blue Shield of California EPN |
$771.17
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Senior |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$143.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.98
|
| Rate for Payer: Heritage Provider Network Senior |
$111.98
|
| Rate for Payer: Humana Medicare |
$143.75
|
| Rate for Payer: IEHP Medi-Cal |
$155.44
|
| Rate for Payer: IEHP Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$135.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.75
|
| Rate for Payer: TriValley Medical Group Senior |
$143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$155.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC LAB REF TISSUE CULTURE NEO BLOOD/BONE
|
Facility
IP
|
$180.91
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900912791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$135.68 |
| Rate for Payer: Adventist Health Commercial |
$36.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.29
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.48
|
| Rate for Payer: Heritage Provider Network Senior |
$122.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.23
|
| Rate for Payer: Multiplan Commercial |
$135.68
|
|
|
HC LAB REF TISSUE CULTURE NEO SOLID TUMOR
|
Facility
IP
|
$211.30
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900912792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$158.48 |
| Rate for Payer: Adventist Health Commercial |
$42.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.16
|
| Rate for Payer: Cash Price |
$95.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.05
|
| Rate for Payer: Heritage Provider Network Senior |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.82
|
| Rate for Payer: Multiplan Commercial |
$158.48
|
|
|
HC LAB REF TISSUE CULTURE NEO SOLID TUMOR
|
Facility
OP
|
$211.30
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900912792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$1,194.87 |
| Rate for Payer: Adventist Health Commercial |
$42.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$429.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,194.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,152.21
|
| Rate for Payer: Blue Shield of California EPN |
$900.74
|
| Rate for Payer: Cash Price |
$95.09
|
| Rate for Payer: Cash Price |
$95.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.79
|
| Rate for Payer: Heritage Provider Network Senior |
$130.79
|
| Rate for Payer: Humana Medicare |
$147.52
|
| Rate for Payer: IEHP Medi-Cal |
$204.55
|
| Rate for Payer: IEHP Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.88
|
| Rate for Payer: Multiplan Commercial |
$158.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC LAB REF TISSUE CULTURE SKIN/SOLID TISS
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.40
|
| Rate for Payer: Heritage Provider Network Senior |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC LAB REF TISSUE CULTURE SKIN/SOLID TISS
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$1,099.16 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$409.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$999.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.16
|
| Rate for Payer: Blue Shield of California EPN |
$859.27
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Humana Medicare |
$140.73
|
| Rate for Payer: IEHP Medi-Cal |
$195.12
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC LAB REF TISSUE INSITU INTERP & REPORT
|
Facility
IP
|
$48.10
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
900910703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$36.08 |
| Rate for Payer: Adventist Health Commercial |
$9.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.04
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.56
|
| Rate for Payer: Heritage Provider Network Senior |
$32.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.02
|
| Rate for Payer: Multiplan Commercial |
$36.08
|
|
