|
HC CHOLESTEROL HDL DIRECT
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
900910528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$80.79 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.79
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.19
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.97
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.63
|
| Rate for Payer: United Healthcare All Other HMO |
$6.63
|
| Rate for Payer: United Healthcare HMO Rider |
$6.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$8.19
|
|
|
HC CHOLESTEROL HDL-DIRECT INDIV
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
900910527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC CHOLESTEROL HDL-DIRECT INDIV
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
900910527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$80.79 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.79
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.19
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.97
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.63
|
| Rate for Payer: United Healthcare All Other HMO |
$6.63
|
| Rate for Payer: United Healthcare HMO Rider |
$6.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$8.19
|
|
|
HC CHOLESTEROL LDL-DIRECT
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
900910529
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC CHOLESTEROL LDL-DIRECT
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
900910529
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$93.16 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.16
|
| Rate for Payer: Blue Shield of California Commercial |
$45.49
|
| Rate for Payer: Blue Shield of California EPN |
$30.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.18
|
| Rate for Payer: EPIC Health Plan Senior |
$10.50
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.07
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.51
|
| Rate for Payer: United Healthcare All Other HMO |
$8.51
|
| Rate for Payer: United Healthcare HMO Rider |
$8.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10.50
|
|
|
HC CHOLESTEROL TOTAL
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.96
|
| Rate for Payer: Blue Shield of California Commercial |
$31.44
|
| Rate for Payer: Blue Shield of California EPN |
$20.77
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.83
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3.53
|
| Rate for Payer: United Healthcare HMO Rider |
$3.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
HC CHOLESTEROL TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CHOLESTEROL TOTAL INDIVIDUAL
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.96
|
| Rate for Payer: Blue Shield of California Commercial |
$31.44
|
| Rate for Payer: Blue Shield of California EPN |
$20.77
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.83
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3.53
|
| Rate for Payer: United Healthcare HMO Rider |
$3.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
HC CHOLESTEROL TOTAL INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CHOME PLATING PER BAR
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L2750
|
| Hospital Charge Code |
905352750
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Shield of California Commercial |
$94.46
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC CHOME PLATING PER BAR
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L2750
|
| Hospital Charge Code |
905352750
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC CHOME PLATING PER BAR
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L2750
|
| Hospital Charge Code |
915352750
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC CHOME PLATING PER BAR
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L2750
|
| Hospital Charge Code |
915352750
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Shield of California Commercial |
$94.46
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC CHORIONIC VILLUS SAMPLING, ANY METHOD
|
Facility
|
IP
|
$2,004.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.80 |
| Max. Negotiated Rate |
$1,703.40 |
| Rate for Payer: Adventist Health Commercial |
$400.80
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.60
|
| Rate for Payer: EPIC Health Plan Senior |
$801.60
|
| Rate for Payer: Galaxy Health WC |
$1,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,202.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,240.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.96
|
| Rate for Payer: Multiplan Commercial |
$1,603.20
|
| Rate for Payer: Networks By Design Commercial |
$1,302.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,703.40
|
|
|
HC CHORIONIC VILLUS SAMPLING, ANY METHOD
|
Facility
|
OP
|
$2,004.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$400.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna of CA HMO |
$1,282.56
|
| Rate for Payer: Cigna of CA PPO |
$1,482.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1,106.36
|
| Rate for Payer: Galaxy Health WC |
$1,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,202.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,814.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,394.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,482.52
|
| Rate for Payer: Multiplan Commercial |
$1,603.20
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: Networks By Design Commercial |
$1,302.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,703.40
|
| Rate for Payer: Prime Health Services WC |
$1,744.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,202.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC CHROM ADDL CELL COUNT EA
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900918013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$159.39 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.39
|
| Rate for Payer: Blue Shield of California Commercial |
$52.18
|
| Rate for Payer: Blue Shield of California EPN |
$34.48
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| 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 |
$18.72
|
| 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 |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| 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: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC CHROM ADDL CELL COUNT EA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900918013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC CHROM ADDL SPEC BANDING
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.71
|
| Rate for Payer: Blue Shield of California Commercial |
$62.22
|
| Rate for Payer: Blue Shield of California EPN |
$41.11
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.61
|
| Rate for Payer: EPIC Health Plan Senior |
$68.60
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| 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 |
$22.32
|
| 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 |
$74.40
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| 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: Upland Medical Group Pediatric |
$68.60
|
| 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
|
$133.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC CHROM ADDTL CELL COUNT EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
910408285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC CHROM ADDTL CELL COUNT EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
910408285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$159.39 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.39
|
| Rate for Payer: Blue Shield of California Commercial |
$121.09
|
| Rate for Payer: Blue Shield of California EPN |
$80.00
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| 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 |
$43.44
|
| 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 |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| 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: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| 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
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC CHROM AMNIO 15 CELLS 1 KARYO
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$1,775.60 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,775.60
|
| Rate for Payer: Blue Shield of California Commercial |
$164.57
|
| Rate for Payer: Blue Shield of California EPN |
$108.73
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.57
|
| Rate for Payer: EPIC Health Plan Senior |
$188.57
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| 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 |
$59.04
|
| 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 |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| 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: Upland Medical Group Pediatric |
$188.57
|
| 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 6-12 COLN 1 KARYO
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
910408269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
910408269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$1,642.68 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,642.68
|
| Rate for Payer: Blue Shield of California Commercial |
$121.09
|
| Rate for Payer: Blue Shield of California EPN |
$80.00
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.44
|
| Rate for Payer: EPIC Health Plan Senior |
$173.66
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| 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 |
$43.44
|
| 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 |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| 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: Upland Medical Group Pediatric |
$173.66
|
| 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
|
|
