|
HC LAB REF IGF-BP2
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.36
|
| Rate for Payer: Heritage Provider Network Senior |
$45.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
|
|
HC LAB REF IGF-BP2
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.29
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C1Q
|
Facility
|
IP
|
$72.18
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912836
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$54.13 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.48
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$54.13
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C1Q
|
Facility
|
OP
|
$72.18
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912836
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$54.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C3D
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.16
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.84
|
| Rate for Payer: Heritage Provider Network Senior |
$54.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C3D
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.14
|
| Rate for Payer: Heritage Provider Network Senior |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL PEG
|
Facility
|
IP
|
$72.19
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911375
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$54.14 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.49
|
| Rate for Payer: Cash Price |
$32.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$54.14
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL PEG
|
Facility
|
OP
|
$72.19
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911375
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$196.13
|
| Rate for Payer: Blue Shield of California EPN |
$157.31
|
| Rate for Payer: Cash Price |
$32.49
|
| Rate for Payer: Cash Price |
$32.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.69
|
| Rate for Payer: Heritage Provider Network Senior |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$54.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNO FIXATION ELECTROPHORESI
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900912722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$212.09 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.09
|
| Rate for Payer: Blue Shield of California Commercial |
$179.77
|
| Rate for Payer: Blue Shield of California EPN |
$144.19
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.80
|
| Rate for Payer: Heritage Provider Network Senior |
$110.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC LAB REF IMMUNO FIXATION ELECTROPHORESI
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900912722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.28
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC LAB REF IMMUNO FIXATION ELECTRO UR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.27
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.82
|
| Rate for Payer: Heritage Provider Network Senior |
$31.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
|
|
HC LAB REF IMMUNO FIXATION ELECTRO UR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$236.16
|
| Rate for Payer: Blue Shield of California EPN |
$189.42
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.09
|
| Rate for Payer: Heritage Provider Network Senior |
$29.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.35
|
| Rate for Payer: TriValley Medical Group Senior |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC LAB REF IMMUNOGLOBULINS IGA SALIVARY
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900911376
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.76
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC LAB REF IMMUNOGLOBULINS IGA SALIVARY
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900911376
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.57
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC LAB REF INFLUENZA A AB IGM
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$131.17 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC LAB REF INFLUENZA A AB IGM
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.95
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.51
|
| Rate for Payer: Heritage Provider Network Senior |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
|
|
HC LAB REF INFLUENZA B AB IGM
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.15
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.42
|
| Rate for Payer: Heritage Provider Network Senior |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
|
|
HC LAB REF INFLUENZA B AB IGM
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900912807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$131.17 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$109.09
|
| Rate for Payer: Blue Shield of California EPN |
$87.50
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC LAB REF INTERPHASE IN SITU HYBRIDIZATI
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900912582
|
|
Hospital Revenue Code
|
310
|
| 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 INTERPHASE IN SITU HYBRIDIZATI
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900912582
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$2,485.29 |
| 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 |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| 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 |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| 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 |
$51.19
|
| 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 |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC LAB REF ISLET CELL ANTIBODIES
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.97
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.35
|
| Rate for Payer: Heritage Provider Network Senior |
$110.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
|
|
HC LAB REF ISLET CELL ANTIBODIES
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.00
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.90
|
| Rate for Payer: Heritage Provider Network Senior |
$100.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC LAB REF KIDNEY BEAN (RED) IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912529
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.37
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC LAB REF KIDNEY BEAN (RED) IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912529
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LAB REF LCM IGG
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
900911470
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.34
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
