|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
OP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.69
|
| Rate for Payer: Heritage Provider Network Senior |
$91.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$111.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
IP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$111.10 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Multiplan Commercial |
$111.10
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
OP
|
$25.56
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$115.24 |
| Rate for Payer: Adventist Health Commercial |
$5.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.24
|
| Rate for Payer: Blue Shield of California Commercial |
$100.57
|
| Rate for Payer: Blue Shield of California EPN |
$80.67
|
| Rate for Payer: Cash Price |
$25.56
|
| Rate for Payer: Cash Price |
$25.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.17
|
| Rate for Payer: Dignity Health Senior |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.82
|
| Rate for Payer: Heritage Provider Network Senior |
$15.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$19.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.79
|
| Rate for Payer: TriValley Medical Group Senior |
$13.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
IP
|
$25.56
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$19.17 |
| Rate for Payer: Adventist Health Commercial |
$5.11
|
| Rate for Payer: Cash Price |
$25.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.30
|
| Rate for Payer: Heritage Provider Network Senior |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.39
|
| Rate for Payer: Multiplan Commercial |
$19.17
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
IP
|
$144.56
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$108.42 |
| Rate for Payer: Adventist Health Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$144.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.87
|
| Rate for Payer: Heritage Provider Network Senior |
$97.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.14
|
| Rate for Payer: Multiplan Commercial |
$108.42
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
OP
|
$144.56
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$28.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$144.56
|
| Rate for Payer: Cash Price |
$144.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.48
|
| Rate for Payer: Heritage Provider Network Senior |
$89.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$108.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HIV-1 ANTIBODY
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.07
|
| Rate for Payer: Blue Shield of California Commercial |
$71.48
|
| Rate for Payer: Blue Shield of California EPN |
$57.33
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.42
|
| Rate for Payer: Heritage Provider Network Senior |
$18.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC SOM HIV-1 ANTIBODY
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.15
|
| Rate for Payer: Heritage Provider Network Senior |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
|
|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$4,001.55 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,001.55
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$797.50
|
| Rate for Payer: Dignity Health Senior |
$725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$725.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$913.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$913.50
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$725.00
|
| Rate for Payer: TriValley Medical Group Senior |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$783.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Vantage Medical Group Senior |
$725.00
|
|
|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.80
|
| Rate for Payer: Heritage Provider Network Senior |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
|
|
HC SOM HIV-1 PROVIRAL DNA
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
900914170
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM HIV-1 PROVIRAL DNA
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
900914170
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC SOM HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$684.81
|
| Rate for Payer: Blue Shield of California EPN |
$549.27
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Senior |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$85.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.23
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$85.10
|
| Rate for Payer: TriValley Medical Group Senior |
$85.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIV2 86702
|
Facility
|
OP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.38
|
| 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 |
$19.37
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.99
|
| Rate for Payer: Heritage Provider Network Senior |
$11.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV2 86702
|
Facility
|
IP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.53 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.11
|
| Rate for Payer: Heritage Provider Network Senior |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
IP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$33.93 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.63
|
| Rate for Payer: Heritage Provider Network Senior |
$30.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
OP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.38
|
| 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 |
$45.24
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.00
|
| Rate for Payer: Heritage Provider Network Senior |
$28.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.13
|
| Rate for Payer: Heritage Provider Network Senior |
$39.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$43.35
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.38
|
| 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 |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.78
|
| Rate for Payer: Heritage Provider Network Senior |
$35.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$43.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$684.81
|
| Rate for Payer: Blue Shield of California EPN |
$549.27
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Senior |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$85.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.23
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$85.10
|
| Rate for Payer: TriValley Medical Group Senior |
$85.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC SOM HIVE 86703
|
Facility
|
IP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.48
|
| Rate for Payer: Heritage Provider Network Senior |
$77.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
|
|
HC SOM HIVE 86703
|
Facility
|
OP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.01
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.84
|
| Rate for Payer: Heritage Provider Network Senior |
$70.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
IP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.13
|
| Rate for Payer: Heritage Provider Network Senior |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
|
