|
HC CHROM ADDL CELL COUNT EA
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900918013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC CHROM ADDL CELL COUNT EA
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900918013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$158.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.23
|
| Rate for Payer: BCBS Transplant Transplant |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.41
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Media |
$26.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$44.13
|
| Rate for Payer: IEHP Medi-Cal |
$43.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$43.59
|
| Rate for Payer: IEHP Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC CHROM ADDL SPEC BANDING
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$68.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.02
|
| Rate for Payer: BCBS Transplant Transplant |
$57.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.37
|
| Rate for Payer: Blue Shield of California EPN |
$48.64
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.90
|
| Rate for Payer: Dignity Health Media |
$68.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$68.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.60
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$112.50
|
| Rate for Payer: IEHP Medi-Cal |
$111.13
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$111.13
|
| Rate for Payer: IEHP Medicare Advantage |
$68.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.92
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.57
|
| Rate for Payer: United Healthcare All Other HMO |
$55.57
|
| Rate for Payer: United Healthcare HMO Rider |
$55.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: Vantage Medical Group Senior |
$68.60
|
|
|
HC CHROM ADDL SPEC BANDING
|
Facility
IP
|
$136.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC CHROM ADDTL CELL COUNT EA
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
910408285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC CHROM ADDTL CELL COUNT EA
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
910408285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.23
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$137.60
|
| Rate for Payer: Blue Shield of California EPN |
$109.06
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Media |
$26.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$44.13
|
| Rate for Payer: IEHP Medi-Cal |
$43.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$43.59
|
| Rate for Payer: IEHP Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC CHROM AMNIO 15 CELLS 1 KARYO
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$1,640.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,494.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,640.14
|
| Rate for Payer: BCBS Transplant Transplant |
$151.20
|
| Rate for Payer: Blue Shield of California Commercial |
$162.79
|
| Rate for Payer: Blue Shield of California EPN |
$129.02
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Media |
$188.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.57
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.25
|
| Rate for Payer: Heritage Provider Network Transplant |
$309.25
|
| Rate for Payer: IEHP Medi-Cal |
$305.48
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$305.48
|
| Rate for Payer: IEHP Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.74
|
| Rate for Payer: United Healthcare All Other HMO |
$152.74
|
| Rate for Payer: United Healthcare HMO Rider |
$152.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC CHROM AMNIO 15 CELLS 1 KARYO
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
910408269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$1,517.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,383.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,517.36
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$137.60
|
| Rate for Payer: Blue Shield of California EPN |
$109.06
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Media |
$173.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$173.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$173.66
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$284.80
|
| Rate for Payer: IEHP Medi-Cal |
$281.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$281.33
|
| Rate for Payer: IEHP Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
910408269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900918014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$1,517.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,383.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,517.36
|
| Rate for Payer: BCBS Transplant Transplant |
$141.00
|
| Rate for Payer: Blue Shield of California Commercial |
$151.81
|
| Rate for Payer: Blue Shield of California EPN |
$120.32
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Media |
$173.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$173.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$173.66
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$176.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$284.80
|
| Rate for Payer: IEHP Medi-Cal |
$281.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$281.33
|
| Rate for Payer: IEHP Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
IP
|
$329.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900918014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC CHROM ANALYSIS ADDL KARYO
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
910408280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$228.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.99
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$137.60
|
| Rate for Payer: Blue Shield of California EPN |
$109.06
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Media |
$33.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.47
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.89
|
| Rate for Payer: IEHP Medi-Cal |
$54.22
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$54.22
|
| Rate for Payer: IEHP Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC CHROM ANALYSIS ADDL KARYO
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
910408280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC CHROM ANALYSIS AMNIO/CVS
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
910408267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.96 |
| Max. Negotiated Rate |
$1,640.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,494.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,640.14
|
| Rate for Payer: BCBS Transplant Transplant |
$212.40
|
| Rate for Payer: Blue Shield of California Commercial |
$228.68
|
| Rate for Payer: Blue Shield of California EPN |
$181.25
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna of CA HMO |
$226.56
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Media |
$188.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.57
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.25
|
| Rate for Payer: Heritage Provider Network Transplant |
$309.25
|
| Rate for Payer: IEHP Medi-Cal |
$305.48
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$305.48
|
| Rate for Payer: IEHP Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.74
|
| Rate for Payer: United Healthcare All Other HMO |
$152.74
|
| Rate for Payer: United Healthcare HMO Rider |
$152.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC CHROM ANALYSIS AMNIO/CVS
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
910408267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.96 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.96
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC CHROM ANLZ 15-20 CELLS 2 KARYO
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900918020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC CHROM ANLZ 15-20 CELLS 2 KARYO
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900918020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$1,137.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,137.14
|
| Rate for Payer: BCBS Transplant Transplant |
$104.40
|
| Rate for Payer: Blue Shield of California Commercial |
$112.40
|
| Rate for Payer: Blue Shield of California EPN |
$89.09
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Media |
$125.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$125.49
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$205.80
|
| Rate for Payer: IEHP Medi-Cal |
$203.29
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$203.29
|
| Rate for Payer: IEHP Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.65
|
| Rate for Payer: United Healthcare All Other HMO |
$101.65
|
| Rate for Payer: United Healthcare HMO Rider |
$101.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC CHROM ANLZ 20-25 CELLS
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC CHROM ANLZ 20-25 CELLS
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$1,132.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.11
|
| Rate for Payer: BCBS Transplant Transplant |
$104.40
|
| Rate for Payer: Blue Shield of California Commercial |
$112.40
|
| Rate for Payer: Blue Shield of California EPN |
$89.09
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.92
|
| Rate for Payer: Dignity Health Media |
$144.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.61
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$237.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$237.16
|
| Rate for Payer: IEHP Medi-Cal |
$234.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$234.27
|
| Rate for Payer: IEHP Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$1,326.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,326.64
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$137.60
|
| Rate for Payer: Blue Shield of California EPN |
$109.06
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.44
|
| Rate for Payer: Dignity Health Media |
$150.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.29
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$246.48
|
| Rate for Payer: IEHP Medi-Cal |
$243.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$243.47
|
| Rate for Payer: IEHP Medicare Advantage |
$150.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.39
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.73
|
| Rate for Payer: United Healthcare All Other HMO |
$121.73
|
| Rate for Payer: United Healthcare HMO Rider |
$121.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Vantage Medical Group Senior |
$150.29
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
|
|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$1,469.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,469.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$396.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$264.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,368.83
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$191.86
|
| Rate for Payer: Blue Shield of California EPN |
$152.06
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.51
|
| Rate for Payer: Dignity Health Media |
$264.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$264.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$264.34
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$433.52
|
| Rate for Payer: IEHP Medi-Cal |
$428.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$428.23
|
| Rate for Payer: IEHP Medicare Advantage |
$264.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.22
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.12
|
| Rate for Payer: United Healthcare All Other HMO |
$214.12
|
| Rate for Payer: United Healthcare HMO Rider |
$214.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Vantage Medical Group Senior |
$264.34
|
|
|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
