|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC LAB REF ENTEROVIRUS AB POLIO 3
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$18.73
|
| Rate for Payer: Blue Shield of California EPN |
$12.38
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.59
|
| Rate for Payer: EPIC Health Plan Senior |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO |
$10.56
|
| Rate for Payer: United Healthcare HMO Rider |
$10.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
HC LAB REF EPI CELL AB BMZ
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900912804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$12.71
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC LAB REF FIBRONECTIN IGA
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$126.44
|
| Rate for Payer: Blue Shield of California EPN |
$83.54
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC LAB REF FIBRONECTIN IGA
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC LAB REF FISH ANEUPLOIDY REFLEX, POC
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912706
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC LAB REF FISH ANEUPLOIDY REFLEX, POC
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912706
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$26.09
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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 |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC LAB REF FISH BCR/ABL FUSION
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910682
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$32.11
|
| Rate for Payer: Blue Shield of California EPN |
$21.22
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| 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 |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$192.00
|
| Rate for Payer: Blue Shield of California EPN |
$126.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| 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 |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC LAB REF FISH HER2/NEU FOR BREAST CANCE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910698
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$230.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$205.38
|
| Rate for Payer: Blue Shield of California EPN |
$135.69
|
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: Cigna of CA HMO |
$196.48
|
| Rate for Payer: Cigna of CA PPO |
$227.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$122.80
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.20
|
| 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 |
$260.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.95
|
| Rate for Payer: Vantage Medical Group Senior |
$260.95
|
|
|
HC LAB REF FISH OPPOSITE SEX BONE MARROW
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910687
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$122.80
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC LAB REF FISH TELOMERIC REGIONS
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910692
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$196.69
|
| Rate for Payer: Blue Shield of California EPN |
$129.95
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| 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 |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC LAB REF FISH WILLIAMS SYNDROME
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910695
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC LAB REF FLUCONAZOLE LEVEL
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC LAB REF FLUCONAZOLE LEVEL
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC LAB REF GAMMA GLOBULIN SUBCLASS
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC LAB REF GAMMA GLOBULIN SUBCLASS
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$329.03 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.03
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.83
|
| Rate for Payer: EPIC Health Plan Senior |
$8.02
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC LAB REF GAUCHER'S DISEASE PCR
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
900910681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
|
|
HC LAB REF GAUCHER'S DISEASE PCR
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
900910681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.28 |
| Max. Negotiated Rate |
$1,111.43 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,111.43
|
| Rate for Payer: Blue Shield of California Commercial |
$321.12
|
| Rate for Payer: Blue Shield of California EPN |
$212.16
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$307.20
|
| Rate for Payer: Cigna of CA PPO |
$355.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.79
|
| Rate for Payer: EPIC Health Plan Senior |
$47.25
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.31
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.28
|
| Rate for Payer: United Healthcare All Other HMO |
$38.28
|
| Rate for Payer: United Healthcare HMO Rider |
$38.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.98
|
| Rate for Payer: Vantage Medical Group Senior |
$47.25
|
|
|
HC LAB REF GREEN COFFEE BEAN IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
