|
HC SOM CHRCB CULTURE 01
|
Facility
|
OP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$1,020.86 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$968.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,020.86
|
| Rate for Payer: Blue Shield of California Commercial |
$41.08
|
| Rate for Payer: Blue Shield of California Commercial |
$62.11
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cigna of CA HMO |
$57.03
|
| Rate for Payer: Cigna of CA PPO |
$65.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.21
|
| Rate for Payer: EPIC Health Plan Senior |
$128.14
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$71.29
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
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 |
$1,224.56 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.56
|
| 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 |
$1,139.62
|
| Rate for Payer: Blue Shield of California Commercial |
$163.42
|
| Rate for Payer: Blue Shield of California Commercial |
$247.09
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$225.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.15
|
| 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 Foundation Hospitals Commercial/Self Funded |
$225.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$209.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.52
|
| 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 Foundation Hospitals Commercial/Self Funded |
$101.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.00
|
| 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 |
$1,106.75 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,050.34
|
| 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 |
$1,106.75
|
| Rate for Payer: Blue Shield of California Commercial |
$111.05
|
| Rate for Payer: Blue Shield of California Commercial |
$73.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$101.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| 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
|
OP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$1,473.44 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,226.79
|
| 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 |
$1,473.44
|
| Rate for Payer: Blue Shield of California Commercial |
$124.37
|
| Rate for Payer: Blue Shield of California Commercial |
$82.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$113.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.28
|
| 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 CHROMIUM
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.66
|
| 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 |
$209.30
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$16.71
|
| Rate for Payer: Cigna of CA PPO |
$19.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22.31
|
| Rate for Payer: Galaxy Health WC |
$22.19
|
| Rate for Payer: Global Benefits Group Commercial |
$15.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$16.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.27
|
| 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 |
$20.89
|
| Rate for Payer: Networks By Design Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Commercial |
$22.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.67
|
| 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
|
Facility
|
IP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.44
|
| Rate for Payer: EPIC Health Plan Senior |
$10.44
|
| Rate for Payer: Galaxy Health WC |
$22.19
|
| Rate for Payer: Global Benefits Group Commercial |
$15.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$20.89
|
| Rate for Payer: Networks By Design Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Commercial |
$22.19
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
IP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.44
|
| Rate for Payer: EPIC Health Plan Senior |
$10.44
|
| Rate for Payer: Galaxy Health WC |
$22.19
|
| Rate for Payer: Global Benefits Group Commercial |
$15.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$20.89
|
| Rate for Payer: Networks By Design Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Commercial |
$22.19
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Cigna of CA PPO |
$19.32
|
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.66
|
| 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 |
$209.30
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$16.71
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22.31
|
| Rate for Payer: Galaxy Health WC |
$22.19
|
| Rate for Payer: Global Benefits Group Commercial |
$15.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$16.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.27
|
| 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 |
$20.89
|
| Rate for Payer: Networks By Design Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Commercial |
$22.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.67
|
| 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
|
OP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$214.79 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.11
|
| 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 |
$214.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.36
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.41
|
| 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 CHROMOSOMAL MICROARRAY
|
Facility
|
OP
|
$1,728.62
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,914.00 |
| Rate for Payer: Adventist Health Commercial |
$345.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,276.42
|
| 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 |
$121.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.85
|
| Rate for Payer: Blue Shield of California Commercial |
$796.89
|
| Rate for Payer: Cash Price |
$1,728.62
|
| Rate for Payer: Cash Price |
$1,728.62
|
| Rate for Payer: Cigna of CA HMO |
$1,106.32
|
| Rate for Payer: Cigna of CA PPO |
$1,279.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,210.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,914.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,276.00
|
| Rate for Payer: Galaxy Health WC |
$1,469.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,037.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,902.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$907.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,097.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,026.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,624.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.87
|
| 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 |
$1,382.90
|
| Rate for Payer: Networks By Design Commercial |
$1,123.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,469.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,037.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,037.17
|
| 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
|
$1,728.62
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$345.72 |
| Max. Negotiated Rate |
$1,469.33 |
| Rate for Payer: Adventist Health Commercial |
$345.72
|
| Rate for Payer: Cash Price |
$1,728.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,210.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$691.45
|
| Rate for Payer: EPIC Health Plan Senior |
$691.45
|
| Rate for Payer: Galaxy Health WC |
$1,469.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,037.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,097.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,019.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.87
|
| Rate for Payer: Multiplan Commercial |
$1,382.90
|
| Rate for Payer: Networks By Design Commercial |
$1,123.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,469.33
|
|
|
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 |
$188.75
|
| 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 |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$169.45
|
| Rate for Payer: Blue Shield of California Commercial |
$112.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.18
|
| 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 Foundation Hospitals Commercial/Self Funded |
$154.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.43
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.18
|
| 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 Foundation Hospitals Commercial/Self Funded |
$154.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.43
|
| 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 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: Cigna of CA PPO |
$703.00
|
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| 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 |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$662.15
|
| Rate for Payer: Blue Shield of California Commercial |
$437.95
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$665.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$603.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$560.50
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$665.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$603.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$560.50
|
| 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 WHOLE BLOOD
|
Facility
|
IP
|
$315.45
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.09 |
| Max. Negotiated Rate |
$268.13 |
| Rate for Payer: Adventist Health Commercial |
$63.09
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.18
|
| Rate for Payer: EPIC Health Plan Senior |
$126.18
|
| Rate for Payer: Galaxy Health WC |
$268.13
|
| Rate for Payer: Global Benefits Group Commercial |
$189.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$186.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.71
|
| Rate for Payer: Multiplan Commercial |
$252.36
|
| Rate for Payer: Networks By Design Commercial |
$205.04
|
| Rate for Payer: Prime Health Services Commercial |
$268.13
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
OP
|
$315.45
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$268.13 |
| Rate for Payer: Adventist Health Commercial |
$63.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$268.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$219.87
|
| Rate for Payer: Blue Shield of California Commercial |
$145.42
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cigna of CA HMO |
$201.89
|
| Rate for Payer: Cigna of CA PPO |
$233.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$268.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$268.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$268.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.18
|
| Rate for Payer: EPIC Health Plan Senior |
$126.18
|
| Rate for Payer: Galaxy Health WC |
$268.13
|
| Rate for Payer: Global Benefits Group Commercial |
$189.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$186.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.81
|
| Rate for Payer: Multiplan Commercial |
$252.36
|
| Rate for Payer: Networks By Design Commercial |
$205.04
|
| Rate for Payer: Prime Health Services Commercial |
$268.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.27
|
| 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 |
$268.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$268.13
|
| Rate for Payer: Vantage Medical Group Senior |
$268.13
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
IP
|
$308.52
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$262.24 |
| Rate for Payer: Multiplan Commercial |
$246.82
|
| Rate for Payer: Networks By Design Commercial |
$200.54
|
| Rate for Payer: Adventist Health Commercial |
$61.70
|
| Rate for Payer: Cash Price |
$308.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$215.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.41
|
| Rate for Payer: EPIC Health Plan Senior |
$123.41
|
| Rate for Payer: Galaxy Health WC |
$262.24
|
| Rate for Payer: Global Benefits Group Commercial |
$185.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$195.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.04
|
| Rate for Payer: Prime Health Services Commercial |
$262.24
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
OP
|
$308.52
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$262.24 |
| Rate for Payer: Adventist Health Commercial |
$61.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$215.04
|
| Rate for Payer: Blue Shield of California Commercial |
$142.23
|
| Rate for Payer: Cash Price |
$308.52
|
| Rate for Payer: Cash Price |
$308.52
|
| Rate for Payer: Cigna of CA HMO |
$197.45
|
| Rate for Payer: Cigna of CA PPO |
$228.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$215.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.41
|
| Rate for Payer: EPIC Health Plan Senior |
$123.41
|
| Rate for Payer: Galaxy Health WC |
$262.24
|
| Rate for Payer: Global Benefits Group Commercial |
$185.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$195.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$246.82
|
| Rate for Payer: Networks By Design Commercial |
$200.54
|
| Rate for Payer: Prime Health Services Commercial |
$262.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$185.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$185.11
|
| 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 |
$262.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.24
|
| Rate for Payer: Vantage Medical Group Senior |
$262.24
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.57
|
| 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 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 |
$192.83 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| 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 |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$25.48
|
| Rate for Payer: Blue Shield of California Commercial |
$16.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.57
|
| 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
|
|
