|
HC SOM CHROMIUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.94
|
| Rate for Payer: Blue Shield of California Commercial |
$194.24
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.38
|
| Rate for Payer: EPIC Health Plan Senior |
$20.28
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: InnovAge PACE Commercial |
$30.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.28
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Prime Health Services Medicare |
$21.50
|
| Rate for Payer: Riverside University Health System MISP |
$22.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO |
$16.43
|
| Rate for Payer: United Healthcare HMO Rider |
$16.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
|
OP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$151.39 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.72
|
| Rate for Payer: Blue Shield of California Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.01
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Central Health Plan Commercial |
$14.12
|
| Rate for Payer: Cigna of CA HMO |
$11.30
|
| Rate for Payer: Cigna of CA PPO |
$13.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: InnovAge PACE Commercial |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$13.24
|
| Rate for Payer: Networks By Design Commercial |
$11.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Central Health Plan Commercial |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Senior |
$7.06
|
| Rate for Payer: Galaxy Health WC |
$15.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$13.24
|
| Rate for Payer: Networks By Design Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$15.00
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Central Health Plan Commercial |
$760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$1,902.40 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,160.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$576.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,160.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.40
|
| Rate for Payer: Blue Shield of California Commercial |
$576.65
|
| Rate for Payer: Blue Shield of California EPN |
$377.15
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Central Health Plan Commercial |
$760.00
|
| Rate for Payer: Cigna of CA HMO |
$608.00
|
| Rate for Payer: Cigna of CA PPO |
$703.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,276.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,566.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,160.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,902.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,160.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,740.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,554.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,554.40
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,160.00
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,229.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,276.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.60
|
| Rate for Payer: United Healthcare All Other HMO |
$939.60
|
| Rate for Payer: United Healthcare HMO Rider |
$939.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,160.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,160.00
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
|
OP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$218.80 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$147.57
|
| Rate for Payer: Blue Shield of California EPN |
$96.51
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Central Health Plan Commercial |
$194.49
|
| Rate for Payer: Cigna of CA HMO |
$155.59
|
| Rate for Payer: Cigna of CA PPO |
$179.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.24
|
| Rate for Payer: EPIC Health Plan Senior |
$97.24
|
| Rate for Payer: Galaxy Health WC |
$206.64
|
| Rate for Payer: Global Benefits Group Commercial |
$145.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$121.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.18
|
| Rate for Payer: Multiplan Commercial |
$182.33
|
| Rate for Payer: Networks By Design Commercial |
$158.02
|
| Rate for Payer: Prime Health Services Commercial |
$206.64
|
| Rate for Payer: Riverside University Health System MISP |
$97.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.87
|
| 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 |
$206.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.64
|
| Rate for Payer: Vantage Medical Group Senior |
$206.64
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
|
IP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$218.80 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Central Health Plan Commercial |
$194.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.24
|
| Rate for Payer: EPIC Health Plan Senior |
$97.24
|
| Rate for Payer: Galaxy Health WC |
$206.64
|
| Rate for Payer: Global Benefits Group Commercial |
$145.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.62
|
| Rate for Payer: Multiplan Commercial |
$182.33
|
| Rate for Payer: Networks By Design Commercial |
$158.02
|
| Rate for Payer: Prime Health Services Commercial |
$206.64
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$576.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$522.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$712.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$576.65
|
| Rate for Payer: Blue Shield of California EPN |
$377.15
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Central Health Plan Commercial |
$760.00
|
| Rate for Payer: Cigna of CA HMO |
$608.00
|
| Rate for Payer: Cigna of CA PPO |
$703.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$807.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$807.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$807.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
| Rate for Payer: Riverside University Health System MISP |
$380.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.00
|
| 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 |
$807.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$807.50
|
| Rate for Payer: Vantage Medical Group Senior |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Central Health Plan Commercial |
$760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.00
|
| Rate for Payer: Galaxy Health WC |
$807.50
|
| Rate for Payer: Global Benefits Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$633.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$588.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: Networks By Design Commercial |
$617.50
|
| Rate for Payer: Prime Health Services Commercial |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$237.34
|
| Rate for Payer: Blue Shield of California EPN |
$155.23
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Riverside University Health System MISP |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$391.00
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$242.80
|
| Rate for Payer: Blue Shield of California EPN |
$158.80
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| 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 |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
OP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$135.91 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$22.19
|
| Rate for Payer: Blue Shield of California EPN |
$14.51
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Central Health Plan Commercial |
$29.25
|
| Rate for Payer: Cigna of CA HMO |
$23.40
|
| Rate for Payer: Cigna of CA PPO |
$27.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Senior |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.59
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| Rate for Payer: Networks By Design Commercial |
$23.76
|
| Rate for Payer: Prime Health Services Commercial |
$31.08
|
| Rate for Payer: Riverside University Health System MISP |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.94
|
| 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 |
$31.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.08
|
| Rate for Payer: Vantage Medical Group Senior |
$31.08
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
IP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Central Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.62
|
| Rate for Payer: EPIC Health Plan Senior |
$14.62
|
| Rate for Payer: Galaxy Health WC |
$31.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| Rate for Payer: Networks By Design Commercial |
$23.76
|
| Rate for Payer: Prime Health Services Commercial |
$31.08
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
OP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$249.25 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$168.11
|
| Rate for Payer: Blue Shield of California EPN |
$109.95
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Central Health Plan Commercial |
$221.56
|
| Rate for Payer: Cigna of CA HMO |
$177.25
|
| Rate for Payer: Cigna of CA PPO |
$204.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.78
|
| Rate for Payer: EPIC Health Plan Senior |
$110.78
|
| Rate for Payer: Galaxy Health WC |
$235.41
|
| Rate for Payer: Global Benefits Group Commercial |
$166.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$138.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.87
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$235.41
|
| Rate for Payer: Riverside University Health System MISP |
$110.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.17
|
| 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 |
$235.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.41
|
| Rate for Payer: Vantage Medical Group Senior |
$235.41
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$249.25 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: Central Health Plan Commercial |
$221.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.78
|
| Rate for Payer: EPIC Health Plan Senior |
$110.78
|
| Rate for Payer: Galaxy Health WC |
$235.41
|
| Rate for Payer: Global Benefits Group Commercial |
$166.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.39
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$235.41
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
|
IP
|
$1,204.78
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.96 |
| Max. Negotiated Rate |
$1,084.30 |
| Rate for Payer: Adventist Health Commercial |
$240.96
|
| Rate for Payer: Cash Price |
$1,204.78
|
| Rate for Payer: Central Health Plan Commercial |
$963.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.91
|
| Rate for Payer: EPIC Health Plan Senior |
$481.91
|
| Rate for Payer: Galaxy Health WC |
$1,024.06
|
| Rate for Payer: Global Benefits Group Commercial |
$722.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,084.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$745.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Multiplan Commercial |
$903.59
|
| Rate for Payer: Networks By Design Commercial |
$783.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.06
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
|
OP
|
$1,204.78
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.99 |
| Max. Negotiated Rate |
$1,084.30 |
| Rate for Payer: Adventist Health Commercial |
$240.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$731.66
|
| 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 Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.39
|
| Rate for Payer: Blue Shield of California Commercial |
$731.30
|
| Rate for Payer: Blue Shield of California EPN |
$478.30
|
| Rate for Payer: Cash Price |
$1,204.78
|
| Rate for Payer: Cash Price |
$1,204.78
|
| Rate for Payer: Central Health Plan Commercial |
$963.82
|
| Rate for Payer: Cigna of CA HMO |
$771.06
|
| Rate for Payer: Cigna of CA PPO |
$891.54
|
| 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 |
$1,024.06
|
| Rate for Payer: Global Benefits Group Commercial |
$722.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,084.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: InnovAge PACE Commercial |
$211.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.59
|
| 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 |
$240.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$903.59
|
| Rate for Payer: Networks By Design Commercial |
$783.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.06
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.87
|
| 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 SOM CHRONIC URTICARIA INDEX
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$97.12
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.82
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: InnovAge PACE Commercial |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Medicare |
$13.21
|
| Rate for Payer: Riverside University Health System MISP |
$13.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
IP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$155.74 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Central Health Plan Commercial |
$138.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.22
|
| Rate for Payer: EPIC Health Plan Senior |
$69.22
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.61
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
OP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$869.10 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.09
|
| 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 Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.39
|
| Rate for Payer: Blue Shield of California Commercial |
$105.04
|
| Rate for Payer: Blue Shield of California EPN |
$68.70
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Central Health Plan Commercial |
$138.43
|
| Rate for Payer: Cigna of CA HMO |
$110.75
|
| Rate for Payer: Cigna of CA PPO |
$128.05
|
| 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 |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: InnovAge PACE Commercial |
$211.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.42
|
| 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 |
$34.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.82
|
| 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
|
|
