|
HC LAB REF CHROMOSOME INTERP & REPORT
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$188.95 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.95
|
| Rate for Payer: Blue Shield of California Commercial |
$102.69
|
| Rate for Payer: Blue Shield of California EPN |
$64.71
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Central Health Plan Commercial |
$130.40
|
| Rate for Payer: Cigna of CA HMO |
$104.32
|
| Rate for Payer: Cigna of CA PPO |
$120.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.10
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
| Rate for Payer: Riverside University Health System MISP |
$65.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.55
|
| Rate for Payer: Vantage Medical Group Senior |
$138.55
|
|
|
HC LAB REF CHROMOSOMES SCE
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.95
|
| Rate for Payer: Blue Shield of California Commercial |
$356.58
|
| Rate for Payer: Blue Shield of California EPN |
$224.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Central Health Plan Commercial |
$452.80
|
| Rate for Payer: Cigna of CA HMO |
$362.24
|
| Rate for Payer: Cigna of CA PPO |
$418.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$509.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$359.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$396.20
|
| Rate for Payer: Multiplan Commercial |
$424.50
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: Riverside University Health System MISP |
$226.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.60
|
| 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 |
$481.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.10
|
| Rate for Payer: Vantage Medical Group Senior |
$481.10
|
|
|
HC LAB REF CHROMOSOMES SCE
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900915261
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Central Health Plan Commercial |
$452.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$509.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$359.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.20
|
| Rate for Payer: Multiplan Commercial |
$424.50
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC LAB REF CLOMIPRAMINE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$71.19
|
| Rate for Payer: Blue Shield of California EPN |
$44.86
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$1,260.55 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$125.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$914.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$906.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,260.55
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| 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 |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.06
|
| Rate for Payer: EPIC Health Plan Senior |
$138.04
|
| 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: Heritage Provider Network Commercial/Senior |
$205.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$185.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$125.49
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$133.02
|
| Rate for Payer: Riverside University Health System MISP |
$138.04
|
| 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 |
$101.65
|
| Rate for Payer: United Healthcare All Other HMO |
$101.65
|
| Rate for Payer: United Healthcare HMO Rider |
$101.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$125.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC LAB REF COUNT 15-20 COLONIES 2 KARYOT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900910763
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| 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 LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC LAB REF COUNT 6-12 COLONIES, 1 KARYOTY
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900910738
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$1,682.03 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$173.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,220.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,209.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,682.03
|
| Rate for Payer: Blue Shield of California Commercial |
$168.21
|
| Rate for Payer: Blue Shield of California EPN |
$106.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.54
|
| Rate for Payer: EPIC Health Plan Senior |
$191.03
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$173.66
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Prime Health Services Medicare |
$184.08
|
| Rate for Payer: Riverside University Health System MISP |
$191.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC LAB REF CRYOPRESERVATION CELL LINE EA
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900912793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care 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 |
$46.17
|
| Rate for Payer: Blue Shield of California Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.57
|
| Rate for Payer: EPIC Health Plan Senior |
$14.38
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.07
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.85
|
| Rate for Payer: Riverside University Health System MISP |
$14.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| 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 |
$10.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC LAB REF CRYPTOCOCCUS AB
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900911339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$124.33 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.33
|
| Rate for Payer: Blue Shield of California Commercial |
$61.74
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.85
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.41
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Medicare |
$15.27
|
| Rate for Payer: Riverside University Health System MISP |
$15.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
|
|
HC LAB REF CRYPTOCOCCUS AB CSF
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86641
|
| Hospital Charge Code |
900912518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$124.33 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.33
|
| Rate for Payer: Blue Shield of California Commercial |
$35.28
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.85
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.41
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Medicare |
$15.27
|
| Rate for Payer: Riverside University Health System MISP |
$15.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$98.91
|
| Rate for Payer: Blue Shield of California EPN |
$62.33
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.39
|
| Rate for Payer: EPIC Health Plan Senior |
$16.93
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.39
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Prime Health Services Medicare |
$16.31
|
| Rate for Payer: Riverside University Health System MISP |
$16.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE FOR MYCOPLASMA
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900911525
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
|
|
HC LAB REF CULTURE MYCOPLASMA PNEUMONIAE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912762
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$66.15
|
| Rate for Payer: Blue Shield of California EPN |
$41.69
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.39
|
| Rate for Payer: EPIC Health Plan Senior |
$16.93
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.39
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$16.31
|
| Rate for Payer: Riverside University Health System MISP |
$16.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF CULTURE MYCOPLASMA PNEUMONIAE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912762
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| 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 LAB REF CULTURE UREAPLASMA UREALYTICUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
900912763
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.39
|
| Rate for Payer: EPIC Health Plan Senior |
$16.93
|
| 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: Heritage Provider Network Commercial/Senior |
$25.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.39
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$16.31
|
| Rate for Payer: Riverside University Health System MISP |
$16.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.46
|
| Rate for Payer: United Healthcare HMO Rider |
$12.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.93
|
| Rate for Payer: Vantage Medical Group Senior |
$15.39
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.63
|
| Rate for Payer: Blue Shield of California Commercial |
$88.83
|
| Rate for Payer: Blue Shield of California EPN |
$55.98
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$90.24
|
| Rate for Payer: Cigna of CA PPO |
$104.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.70
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Riverside University Health System MISP |
$56.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$70.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC LAB REF DESIPRAMINE P
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC LAB REF DISOPYRAMIDE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$39.06
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC LAB REF DISOPYRAMIDE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
|
