|
HC LAB REF CHORIONIC VILLUS
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900912555
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$1,775.60 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| 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 |
$192.67
|
| Rate for Payer: Blue Shield of California EPN |
$127.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| 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 |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| 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 |
$192.10
|
| 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 |
$69.12
|
| 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 |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| 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 LAB REF CHROMOSOMAL IN SITU HYBRIDIZAT
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912581
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC LAB REF CHROMOSOMAL IN SITU HYBRIDIZAT
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912581
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,876.81 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.81
|
| Rate for Payer: Blue Shield of California Commercial |
$219.43
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Senior |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 88299
|
| Hospital Charge Code |
900912794
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$111.34 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.22
|
| Rate for Payer: Blue Shield of California Commercial |
$86.30
|
| Rate for Payer: Blue Shield of California EPN |
$57.02
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC LAB REF CHROMOSOME ANALYSIS 20-25 CELL
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 88299
|
| Hospital Charge Code |
900912794
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC LAB REF CHROMOSOME IN SITU HYB 10-30 C
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912795
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$1,876.81 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.81
|
| Rate for Payer: Blue Shield of California Commercial |
$34.79
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Senior |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC LAB REF CHROMOSOME IN SITU HYB 10-30 C
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900912795
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| 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 LAB REF CHROMOSOME INTERP & REPORT
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$138.55 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.12
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
|
|
HC LAB REF CHROMOSOME INTERP & REPORT
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$109.05
|
| Rate for Payer: Blue Shield of California EPN |
$72.05
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cigna of CA HMO |
$104.32
|
| Rate for Payer: Cigna of CA PPO |
$120.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.10
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.55
|
| Rate for Payer: Vantage Medical Group Senior |
$138.55
|
|
|
HC LAB REF CHROMOSOMES SCE
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
|
|
HC LAB REF CHROMOSOMES SCE
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$378.65
|
| Rate for Payer: Blue Shield of California EPN |
$250.17
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna of CA HMO |
$362.24
|
| Rate for Payer: Cigna of CA PPO |
$418.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$396.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$396.20
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.10
|
| Rate for Payer: Vantage Medical Group Senior |
$481.10
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$49.95
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$1,231.06 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.06
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.41
|
| Rate for Payer: EPIC Health Plan Senior |
$125.49
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| 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 |
$48.00
|
| 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 |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| 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: Upland Medical Group Pediatric |
$125.49
|
| 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 LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$226.95 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.08
|
| Rate for Payer: Multiplan Commercial |
$213.60
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$1,642.68 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.13
|
| 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 |
$178.62
|
| Rate for Payer: Blue Shield of California EPN |
$118.01
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| 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 |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| 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 |
$178.09
|
| 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 |
$64.08
|
| 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 |
$213.60
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| 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
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.08
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California EPN |
$7.07
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$13.07
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$121.42 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.42
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| 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 LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$121.42 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.42
|
| Rate for Payer: Blue Shield of California Commercial |
$37.46
|
| Rate for Payer: Blue Shield of California EPN |
$24.75
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$151.95 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.95
|
| Rate for Payer: Blue Shield of California Commercial |
$105.03
|
| Rate for Payer: Blue Shield of California EPN |
$69.39
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.39
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
|
