|
HC SOM FIAIA 82397
|
Facility
OP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: BCBS Transplant Transplant |
$111.75
|
| Rate for Payer: Blue Shield of California Commercial |
$115.10
|
| Rate for Payer: Blue Shield of California EPN |
$90.52
|
| Rate for Payer: Caremore Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$83.81
|
| Rate for Payer: Cash Price |
$83.81
|
| Rate for Payer: Central Health Plan Commercial |
$149.00
|
| Rate for Payer: Cigna of CA HMO |
$119.20
|
| Rate for Payer: Cigna of CA PPO |
$137.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$158.31
|
| Rate for Payer: Global Benefits Group Commercial |
$111.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$139.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: IEHP medi-cal |
$23.30
|
| Rate for Payer: IEHP Medicare Advantage |
$14.12
|
| Rate for Payer: Innovage PACE Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$139.69
|
| Rate for Payer: Networks By Design Commercial |
$121.06
|
| Rate for Payer: Prime Health Services Commercial |
$158.31
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$111.75
|
| Rate for Payer: Riverside University Health MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
OP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$11,399.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare 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 |
$1,060.09
|
| Rate for Payer: BCBS Transplant Transplant |
$116.69
|
| Rate for Payer: Blue Shield of California Commercial |
$120.19
|
| Rate for Payer: Blue Shield of California EPN |
$94.52
|
| Rate for Payer: Caremore Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Central Health Plan Commercial |
$155.58
|
| Rate for Payer: Cigna of CA HMO |
$124.47
|
| Rate for Payer: Cigna of CA PPO |
$143.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$165.31
|
| Rate for Payer: Global Benefits Group Commercial |
$116.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$145.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: IEHP medi-cal |
$232.20
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Innovage PACE Commercial |
$211.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.90
|
| 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 |
$145.86
|
| Rate for Payer: Networks By Design Commercial |
$126.41
|
| Rate for Payer: Prime Health Services Commercial |
$165.31
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$116.69
|
| Rate for Payer: Riverside University Health MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.69
|
| 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 |
$11,399.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
IP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$175.03 |
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Central Health Plan Commercial |
$155.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.79
|
| Rate for Payer: Galaxy Health WC |
$165.31
|
| Rate for Payer: Global Benefits Group Commercial |
$116.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.90
|
| Rate for Payer: Multiplan Commercial |
$145.86
|
| Rate for Payer: Networks By Design Commercial |
$126.41
|
| Rate for Payer: Prime Health Services Commercial |
$165.31
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
IP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Central Health Plan Commercial |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
OP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$1,058.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.50
|
| Rate for Payer: BCBS Transplant Transplant |
$8.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.78
|
| Rate for Payer: Caremore Medicare Advantage |
$13.07
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Central Health Plan Commercial |
$11.16
|
| Rate for Payer: Cigna of CA HMO |
$8.93
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.07
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.43
|
| Rate for Payer: IEHP medi-cal |
$21.57
|
| Rate for Payer: IEHP Medicare Advantage |
$13.07
|
| Rate for Payer: Innovage PACE Commercial |
$19.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Medicare |
$13.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.37
|
| Rate for Payer: Riverside University Health MISP |
$14.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,058.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC SOM FIDQL 86331
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC SOM FIDQL 86331
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$106.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.34
|
| Rate for Payer: BCBS Transplant Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: IEHP medi-cal |
$19.77
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Innovage PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: Riverside University Health MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FINA 86382
|
Facility
IP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC SOM FINA 86382
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.65
|
| Rate for Payer: BCBS Transplant Transplant |
$235.80
|
| Rate for Payer: Blue Shield of California Commercial |
$242.87
|
| Rate for Payer: Blue Shield of California EPN |
$191.00
|
| Rate for Payer: Caremore Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.91
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$294.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.73
|
| Rate for Payer: IEHP medi-cal |
$27.90
|
| Rate for Payer: IEHP Medicare Advantage |
$16.91
|
| Rate for Payer: Innovage PACE Commercial |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.66
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Prime Health Services Medicare |
$17.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: Riverside University Health MISP |
$18.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.70
|
| Rate for Payer: United Healthcare All Other HMO |
$13.70
|
| Rate for Payer: United Healthcare HMO Rider |
$13.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Vantage Medical Group Senior |
$16.91
|
|
|
HC SOM FINA 87253
|
Facility
IP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$422.31 |
| Rate for Payer: Cash Price |
$211.15
|
| Rate for Payer: Central Health Plan Commercial |
$375.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.69
|
| Rate for Payer: Galaxy Health WC |
$398.85
|
| Rate for Payer: Global Benefits Group Commercial |
$281.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.85
|
| Rate for Payer: Multiplan Commercial |
$351.92
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$398.85
|
|
|
HC SOM FINA 87253
|
Facility
OP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$422.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.33
|
| Rate for Payer: BCBS Transplant Transplant |
$281.54
|
| Rate for Payer: Blue Shield of California Commercial |
$289.98
|
| Rate for Payer: Blue Shield of California EPN |
$228.05
|
| Rate for Payer: Caremore Medicare Advantage |
$20.20
|
| Rate for Payer: Cash Price |
$211.15
|
| Rate for Payer: Cash Price |
$211.15
|
| Rate for Payer: Central Health Plan Commercial |
$375.38
|
| Rate for Payer: Cigna of CA HMO |
$300.31
|
| Rate for Payer: Cigna of CA PPO |
$347.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.20
|
| Rate for Payer: Galaxy Health WC |
$398.85
|
| Rate for Payer: Global Benefits Group Commercial |
$281.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$351.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.13
|
| Rate for Payer: IEHP medi-cal |
$33.33
|
| Rate for Payer: IEHP Medicare Advantage |
$20.20
|
| Rate for Payer: Innovage PACE Commercial |
$30.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.07
|
| Rate for Payer: Multiplan Commercial |
$351.92
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$398.85
|
| Rate for Payer: Prime Health Services Medicare |
$21.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$281.54
|
| Rate for Payer: Riverside University Health MISP |
$22.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.36
|
| Rate for Payer: United Healthcare All Other HMO |
$16.36
|
| Rate for Payer: United Healthcare HMO Rider |
$16.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Vantage Medical Group Senior |
$20.20
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| 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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FISH B ALL
|
Facility
IP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$153.27 |
| Rate for Payer: Cash Price |
$76.64
|
| Rate for Payer: Central Health Plan Commercial |
$136.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.76
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: Networks By Design Commercial |
$110.70
|
| Rate for Payer: Prime Health Services Commercial |
$144.76
|
|
|
HC SOM FISH B ALL
|
Facility
OP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$144.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$102.18
|
| Rate for Payer: Blue Shield of California Commercial |
$105.25
|
| Rate for Payer: Blue Shield of California EPN |
$82.77
|
| Rate for Payer: Cash Price |
$76.64
|
| Rate for Payer: Cash Price |
$76.64
|
| Rate for Payer: Central Health Plan Commercial |
$136.24
|
| Rate for Payer: Cigna of CA HMO |
$108.99
|
| Rate for Payer: Cigna of CA PPO |
$126.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.76
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$127.72
|
| Rate for Payer: IEHP medi-cal |
$59.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: Networks By Design Commercial |
$110.70
|
| Rate for Payer: Prime Health Services Commercial |
$144.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$102.18
|
| Rate for Payer: Riverside University Health MISP |
$68.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.18
|
| 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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.76
|
| Rate for Payer: Vantage Medical Group Senior |
$144.76
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: IEHP medi-cal |
$70.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: Riverside University Health MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM FISH FOR CLL
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FISH FOR CLL
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| 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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.70
|
| Rate for Payer: Blue Shield of California EPN |
$72.90
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: IEHP medi-cal |
$52.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: Riverside University Health MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: IEHP medi-cal |
$70.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: Riverside University Health MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.75
|
| Rate for Payer: IEHP medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: Riverside University Health MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| 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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
