|
HC LAB REF CHROMOSOMES SCE
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.35
|
| Rate for Payer: Heritage Provider Network Senior |
$350.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$269.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$396.20
|
| Rate for Payer: Multiplan Commercial |
$424.50
|
| 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 Commercial/Exchange |
$481.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.10
|
| Rate for Payer: Vantage Medical Group Senior |
$481.10
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.77
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Senior |
$76.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$170.74 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.95
|
| Rate for Payer: Heritage Provider Network Senior |
$69.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| 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 |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$1,183.39 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,183.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$1,579.07 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$165.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.60
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$127.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$173.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.95
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$43.34 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36.92
|
| Rate for Payer: Blue Shield of California EPN |
$29.61
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.07
|
| Rate for Payer: TriValley Medical Group Senior |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$116.72 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.72
|
| Rate for Payer: Blue Shield of California Commercial |
$106.96
|
| Rate for Payer: Blue Shield of California EPN |
$85.79
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.06
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$116.72 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.72
|
| Rate for Payer: Blue Shield of California Commercial |
$106.96
|
| Rate for Payer: Blue Shield of California EPN |
$85.79
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$146.06 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.06
|
| Rate for Payer: Blue Shield of California Commercial |
$123.84
|
| Rate for Payer: Blue Shield of California EPN |
$99.33
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.39
|
| Rate for Payer: TriValley Medical Group Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.11
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC LAB REF CULTURE MYCOPLASMA PNEUMONIAE
|
Facility
|
OP
|
$93.78
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912762
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$146.06 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.06
|
| Rate for Payer: Blue Shield of California Commercial |
$123.84
|
| Rate for Payer: Blue Shield of California EPN |
$99.33
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.05
|
| Rate for Payer: Heritage Provider Network Senior |
$58.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$70.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.39
|
| Rate for Payer: TriValley Medical Group Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE MYCOPLASMA PNEUMONIAE
|
Facility
|
IP
|
$93.78
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912762
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$70.33 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.39
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.49
|
| Rate for Payer: Heritage Provider Network Senior |
$63.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Multiplan Commercial |
$70.33
|
|
|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$146.06 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.06
|
| Rate for Payer: Blue Shield of California Commercial |
$123.84
|
| Rate for Payer: Blue Shield of California EPN |
$99.33
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.39
|
| Rate for Payer: TriValley Medical Group Senior |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.00
|
| 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 |
$119.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Senior |
$87.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$67.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.70
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| 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 |
$90.80
|
| 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 Foundation Hospitals 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 DISOPYRAMIDE
|
Facility
|
OP
|
$55.30
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$11.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.23
|
| Rate for Payer: Heritage Provider Network Senior |
$34.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$41.48
|
| 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 DISOPYRAMIDE
|
Facility
|
IP
|
$55.30
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$41.48 |
| Rate for Payer: Adventist Health Commercial |
$11.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.61
|
| Rate for Payer: Cash Price |
$24.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.44
|
| Rate for Payer: Heritage Provider Network Senior |
$37.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.82
|
| Rate for Payer: Multiplan Commercial |
$41.48
|
|
|
HC LAB REF DNA PROBE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912580
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.90
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.02
|
| Rate for Payer: Heritage Provider Network Senior |
$23.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
|
|
HC LAB REF DNA PROBE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912580
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.17
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
