|
HC LAB REF BK VIRUS BY PCR
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912606
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$335.41 |
| 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 |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| 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 |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| 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 |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| 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 |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF BK VIRUS BY PCR
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912606
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$30.80
|
| 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 BK VIRUS QUANT PCR, URINE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912695
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$46.16
|
| Rate for Payer: Blue Shield of California EPN |
$30.50
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC LAB REF BK VIRUS QUANT PCR, URINE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912695
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
|
|
HC LAB REF CALCIUM RANDOM URINE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC LAB REF CALCIUM RANDOM URINE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC LAB REF CALCIUM URINE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900910213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC LAB REF CALCIUM URINE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900910213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC LAB REF CALIFORNIA ENCEPH AB IGG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
900911466
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
HC LAB REF CALIFORNIA ENCEPH AB IGG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
900911466
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$14.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF CALIFORNIA ENCEPH AB IGM
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
900912654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$14.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF CALIFORNIA ENCEPH AB IGM
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
900912654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
HC LAB REF CHLAMYDIA PNEUMONIA
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
900912516
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
|
|
HC LAB REF CHLAMYDIA PNEUMONIA
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 87486
|
| Hospital Charge Code |
900912516
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$232.81
|
| Rate for Payer: Blue Shield of California EPN |
$153.82
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF CHLORAL HYDRATE
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.60
|
| Rate for Payer: EPIC Health Plan Senior |
$39.60
|
| Rate for Payer: Galaxy Health WC |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
|
|
HC LAB REF CHLORAL HYDRATE
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.93
|
| 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 |
$66.23
|
| Rate for Payer: Blue Shield of California EPN |
$43.76
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$63.36
|
| Rate for Payer: Cigna of CA PPO |
$73.26
|
| 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 |
$84.15
|
| Rate for Payer: Global Benefits Group Commercial |
$59.40
|
| 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 |
$66.03
|
| 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 |
$23.76
|
| 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 |
$79.20
|
| Rate for Payer: Networks By Design Commercial |
$64.35
|
| Rate for Payer: Prime Health Services Commercial |
$84.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.40
|
| 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 CHORIONIC VILLUS
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900912555
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| 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
|
|
|
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 |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| 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
|
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 |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| 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 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 |
$180.40
|
| 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 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 |
$70.95
|
| Rate for Payer: Cash Price |
$70.95
|
| 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 |
$70.95
|
| 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
|
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 |
$28.60
|
| 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 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 |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| 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 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 |
$89.65
|
| Rate for Payer: Cash Price |
$89.65
|
| 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
|
|
