|
HC CHOLESTEROL HDL DIRECT
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
900910528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC CHOLESTEROL HDL-DIRECT INDIV
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
900910527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC CHOLESTEROL HDL-DIRECT INDIV
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
900910527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$74.68 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.68
|
| Rate for Payer: Blue Shield of California Commercial |
$65.89
|
| Rate for Payer: Blue Shield of California EPN |
$52.85
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Senior |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.19
|
| Rate for Payer: TriValley Medical Group Senior |
$8.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$8.19
|
|
|
HC CHOLESTEROL LDL-DIRECT
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
900910529
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC CHOLESTEROL LDL-DIRECT
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
900910529
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.11
|
| Rate for Payer: Blue Shield of California Commercial |
$76.78
|
| Rate for Payer: Blue Shield of California EPN |
$61.58
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.55
|
| Rate for Payer: Dignity Health Senior |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Senior |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10.50
|
|
|
HC CHOLESTEROL TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC CHOLESTEROL TOTAL
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.71
|
| Rate for Payer: Blue Shield of California Commercial |
$35.02
|
| Rate for Payer: Blue Shield of California EPN |
$28.09
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Senior |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.09
|
| Rate for Payer: Heritage Provider Network Senior |
$29.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.35
|
| Rate for Payer: TriValley Medical Group Senior |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
HC CHOLESTEROL TOTAL INDIVIDUAL
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.71
|
| Rate for Payer: Blue Shield of California Commercial |
$35.02
|
| Rate for Payer: Blue Shield of California EPN |
$28.09
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Senior |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.09
|
| Rate for Payer: Heritage Provider Network Senior |
$29.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.35
|
| Rate for Payer: TriValley Medical Group Senior |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
HC CHOLESTEROL TOTAL INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
900910525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC CHROM ADDL CELL COUNT EA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900918013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC CHROM ADDL CELL COUNT EA
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900918013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$152.87 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.33
|
| Rate for Payer: Blue Shield of California Commercial |
$152.87
|
| Rate for Payer: Blue Shield of California EPN |
$122.61
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC CHROM ADDL SPEC BANDING
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
|
|
HC CHROM ADDL SPEC BANDING
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$102.90 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.07
|
| Rate for Payer: Blue Shield of California Commercial |
$73.84
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.46
|
| Rate for Payer: Dignity Health Senior |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$68.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.44
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$68.60
|
| Rate for Payer: TriValley Medical Group Senior |
$68.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$74.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$74.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: Vantage Medical Group Senior |
$68.60
|
|
|
HC CHROM AMNIO 15 CELLS 1 KARYO
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.50
|
| Rate for Payer: Heritage Provider Network Senior |
$229.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
|
|
HC CHROM AMNIO 15 CELLS 1 KARYO
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$1,641.19 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,641.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,160.41
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$188.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900918014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$240.75 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.32
|
| Rate for Payer: Heritage Provider Network Senior |
$217.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$240.75
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900918014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$1,518.32 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$122.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| 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 HMO/PPO |
$1,518.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.60
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Senior |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Senior |
$142.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.81
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$173.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.55
|
| 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 CHROM ANLZ 15-20 CELLS 2 KARYO
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900918020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$1,137.86 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| 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 HMO/PPO |
$1,137.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| 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 CHROM ANLZ 15-20 CELLS 2 KARYO
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900918020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.83
|
| Rate for Payer: Heritage Provider Network Senior |
$381.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
|
|
HC CHROM ANLZ 20-25 CELLS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.83
|
| Rate for Payer: Heritage Provider Network Senior |
$381.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
|
|
HC CHROM ANLZ 20-25 CELLS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$1,132.82 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.01
|
| Rate for Payer: Heritage Provider Network Senior |
$197.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$1,327.48 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,209.43
|
| Rate for Payer: Blue Shield of California EPN |
$970.06
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.32
|
| Rate for Payer: Dignity Health Senior |
$150.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.75
|
| Rate for Payer: Heritage Provider Network Senior |
$128.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$216.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.37
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.29
|
| Rate for Payer: TriValley Medical Group Senior |
$150.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Vantage Medical Group Senior |
$150.29
|
|
|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,369.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,422.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.82
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.77
|
| Rate for Payer: Dignity Health Senior |
$264.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$264.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$264.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.07
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$264.34
|
| Rate for Payer: TriValley Medical Group Senior |
$264.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$285.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$285.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Vantage Medical Group Senior |
$264.34
|
|
|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.83
|
| Rate for Payer: Heritage Provider Network Senior |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
|
