|
HC LAB REF RAJI CELL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.72
|
| Rate for Payer: Blue Shield of California Commercial |
$112.39
|
| Rate for Payer: Blue Shield of California EPN |
$74.26
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: EPIC Health Plan Senior |
$24.37
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.74
|
| Rate for Payer: United Healthcare All Other HMO |
$19.74
|
| Rate for Payer: United Healthcare HMO Rider |
$19.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF RETICULIN AB
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
HC LAB REF RETICULIN AB
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$119.10 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.18
|
| 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 |
$9.37
|
| Rate for Payer: Blue Shield of California EPN |
$6.19
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| 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 |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| 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 |
$9.34
|
| 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 |
$3.36
|
| 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 |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| 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 RIFAMPIN
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC LAB REF RIFAMPIN
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.86
|
| 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 |
$91.65
|
| Rate for Payer: Blue Shield of California EPN |
$60.55
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| 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 |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| 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 |
$91.38
|
| 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 |
$32.88
|
| 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 |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| 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 ST LOUIS ENCEPH AB IGM
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912652
|
|
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 |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| 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 ST LOUIS ENCEPH AB IGM
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912652
|
|
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 |
$9.45
|
| 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 STRIATIONAL ABS
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$9.45
|
| 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 STRIATIONAL ABS
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$127.87 |
| 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 |
$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 |
$14.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| 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 |
$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 |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| 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 |
$14.01
|
| 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 |
$5.04
|
| 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 |
$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 |
$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 SULFHEMOGLOBIN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900910299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$81.66 |
| 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 |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.66
|
| 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 |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.88
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.79
|
| 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 |
$7.13
|
| Rate for Payer: United Healthcare All Other HMO |
$7.13
|
| Rate for Payer: United Healthcare HMO Rider |
$7.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
HC LAB REF SULFHEMOGLOBIN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900910299
|
|
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 |
$4.50
|
| 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 T3 UPTAKE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900910792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$63.90 |
| 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 |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.90
|
| 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 |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| 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 |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC LAB REF T3 UPTAKE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900910792
|
|
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 |
$4.50
|
| 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 TISSUE CULT OTHER SOLID TISSUE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910776
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| 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 |
$63.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.75
|
| Rate for Payer: Vantage Medical Group Senior |
$63.75
|
|
|
HC LAB REF TISSUE CULT OTHER SOLID TISSUE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910776
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC LAB REF TISSUE CULTURE LYMPHOCYTE NON
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900910686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$976.91 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$976.91
|
| Rate for Payer: Blue Shield of California Commercial |
$67.57
|
| Rate for Payer: Blue Shield of California EPN |
$44.64
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: EPIC Health Plan Senior |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC LAB REF TISSUE CULTURE LYMPHOCYTE NON
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900910686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC LAB REF TISSUE CULTURE NEO BLOOD/BONE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900912791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.10
|
| Rate for Payer: Blue Shield of California Commercial |
$135.81
|
| Rate for Payer: Blue Shield of California EPN |
$89.73
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cigna of CA HMO |
$129.92
|
| Rate for Payer: Cigna of CA PPO |
$150.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Senior |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$162.40
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC LAB REF TISSUE CULTURE NEO BLOOD/BONE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900912791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.72
|
| Rate for Payer: Multiplan Commercial |
$162.40
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
|
|
HC LAB REF TISSUE CULTURE NEO SOLID TUMOR
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900912792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$201.45 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.80
|
| Rate for Payer: EPIC Health Plan Senior |
$94.80
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
|
|
HC LAB REF TISSUE CULTURE NEO SOLID TUMOR
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900912792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.00
|
| Rate for Payer: Blue Shield of California Commercial |
$158.55
|
| Rate for Payer: Blue Shield of California EPN |
$104.75
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cigna of CA HMO |
$151.68
|
| Rate for Payer: Cigna of CA PPO |
$175.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC LAB REF TISSUE CULTURE SKIN/SOLID TISS
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$1,179.99 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,179.99
|
| Rate for Payer: Blue Shield of California Commercial |
$101.02
|
| Rate for Payer: Blue Shield of California EPN |
$66.74
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC LAB REF TISSUE CULTURE SKIN/SOLID TISS
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900912790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
|
|
HC LAB REF TISSUE INSITU INTERP & REPORT
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
900910703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC LAB REF TISSUE INSITU INTERP & REPORT
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
900910703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.56
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
