|
HC CHROM ADDL SPEC BANDING
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 88283
|
| Hospital Charge Code |
900918012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$102.90 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.90
|
| 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 Medi-Cal |
$75.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.31
|
| Rate for Payer: Blue Shield of California Commercial |
$73.84
|
| Rate for Payer: Blue Shield of California Commercial |
$73.84
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| 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: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$68.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$68.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$82.33
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.92
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$68.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$68.60
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$74.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$102.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.46
|
| Rate for Payer: Vantage Medical Group Senior |
$68.60
|
| Rate for Payer: Vantage Medical Group Senior |
$68.60
|
|
|
HC CHROM ADDTL CELL COUNT EA
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
910408285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$153.22 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.86
|
| 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 |
$153.22
|
| 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 |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| 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 ADDTL CELL COUNT EA
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
910408285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.56
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC CHROM AMNIO 15 CELLS 1 KARYO
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900918015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$1,706.85 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$152.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| 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 Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,706.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,706.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.74
|
| 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: Blue Shield of California EPN |
$1,160.41
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| 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: Cigna of CA HMO/PPO |
$220.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.84
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$209.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$117.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$161.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
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: Aetna of CA Non-Gatekeeper |
$218.32
|
| 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 Foundation Hospitals 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 6-12 COLN 1 KARYO
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
910408269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$1,579.07 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.86
|
| 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 |
$1,579.07
|
| 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 |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| 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: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| 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 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: Aetna of CA Non-Gatekeeper |
$206.72
|
| 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 Foundation Hospitals 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
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
910408269
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.56
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC CHROM AMNIO 6-12 COLN 1 KARYO
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900918014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$1,579.07 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| 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 Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.51
|
| 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: Blue Shield of California EPN |
$1,073.60
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| 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: Cigna of CA HMO/PPO |
$208.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.70
|
| Rate for Payer: Heritage Provider Network Senior |
$142.37
|
| Rate for Payer: Heritage Provider Network Senior |
$198.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$109.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$153.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Multiplan Commercial |
$240.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.66
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$187.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC CHROM ANALYSIS ADDL KARYO
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
910408280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.56
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC CHROM ANALYSIS ADDL KARYO
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
910408280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$238.30 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.86
|
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC CHROM ANALYSIS AMNIO/CVS
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
910408267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,706.85 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.02
|
| 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 |
$1,706.85
|
| 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 |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.32
|
| Rate for Payer: Heritage Provider Network Senior |
$186.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$143.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| 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 ANALYSIS AMNIO/CVS
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
910408267
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.84
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.78
|
| Rate for Payer: Heritage Provider Network Senior |
$203.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
|
|
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: Aetna of CA Non-Gatekeeper |
$363.22
|
| 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 Foundation Hospitals 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 15-20 CELLS 2 KARYO
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900918020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$1,183.39 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| 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 Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,183.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,183.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| 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: Cigna of CA HMO/PPO |
$366.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.12
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$349.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$269.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
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: Aetna of CA Non-Gatekeeper |
$363.22
|
| 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 Foundation Hospitals 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
|
$564.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900918016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$1,178.15 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| 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 Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| 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: Cigna of CA HMO/PPO |
$366.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.12
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$349.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$269.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$193.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC CHROM ANLZ 45 CEL MSAIC 2 KRYO
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88263
|
| Hospital Charge Code |
900918017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$1,380.59 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.44
|
| 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 Medi-Cal |
$165.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,380.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,380.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,209.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,209.43
|
| Rate for Payer: Blue Shield of California EPN |
$970.06
|
| Rate for Payer: Blue Shield of California EPN |
$970.06
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| 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: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$128.75
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.39
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.29
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$162.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$225.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.32
|
| Rate for Payer: Vantage Medical Group Senior |
$150.29
|
| Rate for Payer: Vantage Medical Group Senior |
$150.29
|
|
|
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: Aetna of CA Non-Gatekeeper |
$187.40
|
| 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 Foundation Hospitals 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 5 CELLS 1 KARYO
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$1,424.50 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.51
|
| 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 Medi-Cal |
$290.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,424.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,424.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,422.32
|
| 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: Blue Shield of California EPN |
$1,140.82
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| 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: Cigna of CA HMO/PPO |
$261.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$264.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$264.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.46
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$249.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$264.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$264.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$192.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$354.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$354.22
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$264.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$264.34
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$285.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$396.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.77
|
| Rate for Payer: Vantage Medical Group Senior |
$264.34
|
| 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: Aetna of CA Non-Gatekeeper |
$259.53
|
| 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 Foundation Hospitals Medi-Cal |
$72.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$238.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.71
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC CHROMOSOME ANALYSIS; CNT 15-20
|
Facility
|
IP
|
$625.52
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
903800162
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$469.14 |
| Rate for Payer: Adventist Health Commercial |
$125.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$402.83
|
| Rate for Payer: Cash Price |
$281.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.48
|
| Rate for Payer: Heritage Provider Network Senior |
$423.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.38
|
| Rate for Payer: Multiplan Commercial |
$469.14
|
|
|
HC CHROMOSOME ANALYSIS; CNT 15-20
|
Facility
|
OP
|
$625.52
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
903800162
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$1,183.39 |
| Rate for Payer: Adventist Health Commercial |
$125.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.57
|
| 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 |
$1,183.39
|
| 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 |
$281.48
|
| Rate for Payer: Cash Price |
$281.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$406.59
|
| 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: EPIC Health Plan Commercial |
$406.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$387.20
|
| Rate for Payer: Heritage Provider Network Senior |
$387.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$298.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$469.14
|
| 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
|
|
