|
HC LAB REF ENTEROVIRUS AB COXSACKIE B4
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B5
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B5
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B6
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B6
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 11
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911760
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.23
|
| Rate for Payer: Heritage Provider Network Senior |
$12.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 11
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911760
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.38
|
| Rate for Payer: Heritage Provider Network Senior |
$13.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 30
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.23
|
| Rate for Payer: Heritage Provider Network Senior |
$12.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 30
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.38
|
| Rate for Payer: Heritage Provider Network Senior |
$13.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 4
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.23
|
| Rate for Payer: Heritage Provider Network Senior |
$12.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 4
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.38
|
| Rate for Payer: Heritage Provider Network Senior |
$13.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 7
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.38
|
| Rate for Payer: Heritage Provider Network Senior |
$13.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 7
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.21
|
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.23
|
| Rate for Payer: Heritage Provider Network Senior |
$12.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$14.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 9
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.38
|
| Rate for Payer: Heritage Provider Network Senior |
$13.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$14.83
|
|
|
HC LAB REF ENTEROVIRUS AB ECHOVIRUS 9
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.24
|
| Rate for Payer: Heritage Provider Network Senior |
$12.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$14.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 1
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 1
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 2
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912741
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 2
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912741
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.24
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.86
|
| Rate for Payer: Heritage Provider Network Senior |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| 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 |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC LAB REF FIBRONECTIN IGA
|
Facility
|
IP
|
$168.65
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.61
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.18
|
| Rate for Payer: Heritage Provider Network Senior |
$114.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.16
|
| Rate for Payer: Multiplan Commercial |
$126.49
|
|
|
HC LAB REF FIBRONECTIN IGA
|
Facility
|
OP
|
$168.65
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Adventist Health Commercial |
$33.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.39
|
| Rate for Payer: Heritage Provider Network Senior |
$104.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$126.49
|
| 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 |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
