|
HC SOM CHRCV CULTURE 03
|
Facility
|
OP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.55
|
| Rate for Payer: Blue Shield of California Commercial |
$237.16
|
| Rate for Payer: Blue Shield of California EPN |
$156.69
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cigna of CA HMO |
$226.88
|
| Rate for Payer: Cigna of CA PPO |
$262.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
IP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$301.32 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.80
|
| Rate for Payer: EPIC Health Plan Senior |
$141.80
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.08
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
IP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.73
|
| Rate for Payer: EPIC Health Plan Senior |
$63.73
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.24
|
| Rate for Payer: Multiplan Commercial |
$127.46
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
OP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.10
|
| Rate for Payer: Blue Shield of California Commercial |
$106.59
|
| Rate for Payer: Blue Shield of California EPN |
$70.42
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Cigna of CA HMO |
$101.96
|
| Rate for Payer: Cigna of CA PPO |
$117.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Senior |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$127.46
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
IP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$151.67 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.38
|
| Rate for Payer: EPIC Health Plan Senior |
$71.38
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.83
|
| Rate for Payer: Multiplan Commercial |
$142.75
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
OP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.38
|
| Rate for Payer: Blue Shield of California EPN |
$78.87
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cigna of CA HMO |
$114.20
|
| Rate for Payer: Cigna of CA PPO |
$132.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$142.75
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CHROMIUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM CHROMIUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$200.29 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.29
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.38
|
| Rate for Payer: EPIC Health Plan Senior |
$20.28
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO |
$16.43
|
| Rate for Payer: United Healthcare HMO Rider |
$16.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.29
|
| Rate for Payer: Blue Shield of California Commercial |
$214.08
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.38
|
| Rate for Payer: EPIC Health Plan Senior |
$20.28
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO |
$16.43
|
| Rate for Payer: United Healthcare HMO Rider |
$16.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Senior |
$7.06
|
| Rate for Payer: Galaxy Health WC |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.24
|
| Rate for Payer: Multiplan Commercial |
$14.12
|
| Rate for Payer: Networks By Design Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$15.00
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
|
OP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$205.54 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11.81
|
| Rate for Payer: Blue Shield of California EPN |
$7.80
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$11.30
|
| Rate for Payer: Cigna of CA PPO |
$13.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$14.12
|
| Rate for Payer: Networks By Design Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$15.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$116.44 |
| Max. Negotiated Rate |
$1,902.40 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$623.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.44
|
| Rate for Payer: Blue Shield of California Commercial |
$635.55
|
| Rate for Payer: Blue Shield of California EPN |
$419.90
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna of CA HMO |
$608.00
|
| Rate for Payer: Cigna of CA PPO |
$703.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,276.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,566.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,160.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,902.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,461.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,554.40
|
| Rate for Payer: Multiplan Commercial |
$760.00
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.60
|
| Rate for Payer: United Healthcare All Other HMO |
$939.60
|
| Rate for Payer: United Healthcare HMO Rider |
$939.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,160.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,160.00
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Multiplan Commercial |
$760.00
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
|
IP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.24
|
| Rate for Payer: EPIC Health Plan Senior |
$97.24
|
| Rate for Payer: Galaxy Health WC |
$206.64
|
| Rate for Payer: Global Benefits Group Commercial |
$145.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.35
|
| Rate for Payer: Multiplan Commercial |
$194.49
|
| Rate for Payer: Networks By Design Commercial |
$158.02
|
| Rate for Payer: Prime Health Services Commercial |
$206.64
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
|
OP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$162.64
|
| Rate for Payer: Blue Shield of California EPN |
$107.45
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Cigna of CA HMO |
$155.59
|
| Rate for Payer: Cigna of CA PPO |
$179.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.24
|
| Rate for Payer: EPIC Health Plan Senior |
$97.24
|
| Rate for Payer: Galaxy Health WC |
$206.64
|
| Rate for Payer: Global Benefits Group Commercial |
$145.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.18
|
| Rate for Payer: Multiplan Commercial |
$194.49
|
| Rate for Payer: Networks By Design Commercial |
$158.02
|
| Rate for Payer: Prime Health Services Commercial |
$206.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.64
|
| Rate for Payer: Vantage Medical Group Senior |
$206.64
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Multiplan Commercial |
$760.00
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$623.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$522.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$712.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$635.55
|
| Rate for Payer: Blue Shield of California EPN |
$419.90
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna of CA HMO |
$608.00
|
| Rate for Payer: Cigna of CA PPO |
$703.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$807.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$807.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$807.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$760.00
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$807.50
|
| Rate for Payer: Vantage Medical Group Senior |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$261.58
|
| Rate for Payer: Blue Shield of California EPN |
$172.82
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$267.60
|
| Rate for Payer: Blue Shield of California EPN |
$176.80
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
OP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$24.46
|
| Rate for Payer: Blue Shield of California EPN |
$16.16
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Cigna of CA HMO |
$23.40
|
| Rate for Payer: Cigna of CA PPO |
$27.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Senior |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.59
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$23.76
|
| Rate for Payer: Prime Health Services Commercial |
$31.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.08
|
| Rate for Payer: Vantage Medical Group Senior |
$31.08
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
IP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$31.08 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Senior |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$23.76
|
| Rate for Payer: Prime Health Services Commercial |
$31.08
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.78
|
| Rate for Payer: EPIC Health Plan Senior |
$110.78
|
| Rate for Payer: Galaxy Health WC |
$235.41
|
| Rate for Payer: Global Benefits Group Commercial |
$166.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Multiplan Commercial |
$221.56
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$235.41
|
|
