|
HC FIBRINOGEN ASSAY
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$80.16 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.16
|
| Rate for Payer: Blue Shield of California Commercial |
$68.37
|
| Rate for Payer: Blue Shield of California Commercial |
$68.37
|
| Rate for Payer: Blue Shield of California EPN |
$54.84
|
| Rate for Payer: Blue Shield of California EPN |
$54.84
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$194.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$185.08
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$142.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.72
|
| Rate for Payer: TriValley Medical Group Senior |
$9.72
|
| Rate for Payer: TriValley Medical Group Senior |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
HC FIBRINOGEN ASSAY
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
900910013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.56
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.42
|
| Rate for Payer: Heritage Provider Network Senior |
$202.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$622.10 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,124.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,234.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,062.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,127.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,577.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$622.10 |
| Max. Negotiated Rate |
$2,577.75 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,213.43
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,326.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2,326.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.25
|
| Rate for Payer: Multiplan Commercial |
$2,577.75
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$136.66 |
| Max. Negotiated Rate |
$566.25 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.22
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.13
|
| Rate for Payer: Heritage Provider Network Senior |
$511.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.75
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$566.25 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$235.20
|
| Rate for Payer: Blue Shield of California EPN |
$189.14
|
| Rate for Payer: Blue Shield of California EPN |
$189.14
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.35
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$467.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$156.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$360.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$235.20
|
| Rate for Payer: Blue Shield of California EPN |
$189.14
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.52
|
| Rate for Payer: Heritage Provider Network Senior |
$75.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.57
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$942.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$838.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,143.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$991.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,296.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,296.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$943.98
|
| Rate for Payer: Heritage Provider Network Senior |
$943.98
|
| Rate for Payer: Heritage Provider Network Senior |
$181.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$139.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$727.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$205.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,067.50
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Multiplan Commercial |
$219.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$762.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$762.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Senior |
$249.05
|
|
|
HC FINE NEEDLE ASP W IMAGE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 10022
|
| Hospital Charge Code |
903800168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$1,143.75 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.10
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,032.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,032.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$356.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$151.53
|
| Rate for Payer: Blue Shield of California Commercial |
$274.07
|
| Rate for Payer: Blue Shield of California EPN |
$120.58
|
| Rate for Payer: Blue Shield of California EPN |
$218.11
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$275.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$191.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$346.20
|
| Rate for Payer: TriValley Medical Group Senior |
$346.20
|
| Rate for Payer: TriValley Medical Group Senior |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: TriValley Medical Group Senior |
$522.85
|
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$356.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$351.97
|
| Rate for Payer: Blue Shield of California Commercial |
$194.59
|
| Rate for Payer: Blue Shield of California EPN |
$155.67
|
| Rate for Payer: Blue Shield of California EPN |
$281.58
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.16
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$357.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$275.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$522.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$522.85
|
| Rate for Payer: TriValley Medical Group Senior |
$522.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$288.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$288.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.59
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.59
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC FINGERS MIN 2 VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
909001521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$340.68
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$358.13
|
| Rate for Payer: Heritage Provider Network Senior |
$358.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
|
|
HC FINGERS MIN 2 VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
909001521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$326.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.61
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$327.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$252.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC FISH INTERPHASE 100-300 CELLS
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900918011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$2,485.29 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$318.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$334.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.45
|
| Rate for Payer: Heritage Provider Network Senior |
$318.79
|
| Rate for Payer: Heritage Provider Network Senior |
$366.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$245.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$282.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC FISH INTERPHASE 100-300 CELLS
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900918011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.25
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
|
|
HC FISH INTERPHASE 25-99 CELLS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900918010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$1,988.23 |
| Rate for Payer: Adventist Health Commercial |
$42.60
|
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,988.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,988.23
|
| Rate for Payer: Blue Shield of California Commercial |
$280.11
|
| Rate for Payer: Blue Shield of California Commercial |
$280.11
|
| Rate for Payer: Blue Shield of California EPN |
$224.67
|
| Rate for Payer: Blue Shield of California EPN |
$224.67
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.85
|
| Rate for Payer: Heritage Provider Network Senior |
$95.33
|
| Rate for Payer: Heritage Provider Network Senior |
$131.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$73.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.79
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.38
|
| Rate for Payer: TriValley Medical Group Senior |
$42.38
|
| Rate for Payer: TriValley Medical Group Senior |
$42.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC FISH INTERPHASE 25-99 CELLS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900918010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$159.75 |
| Rate for Payer: Adventist Health Commercial |
$42.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.17
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.20
|
| Rate for Payer: Heritage Provider Network Senior |
$144.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.25
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$1,804.13 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,804.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,804.13
|
| Rate for Payer: Blue Shield of California Commercial |
$258.57
|
| Rate for Payer: Blue Shield of California Commercial |
$258.57
|
| Rate for Payer: Blue Shield of California EPN |
$207.39
|
| Rate for Payer: Blue Shield of California EPN |
$207.39
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.42
|
| Rate for Payer: Heritage Provider Network Senior |
$88.52
|
| Rate for Payer: Heritage Provider Network Senior |
$124.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$68.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.44
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.08
|
| Rate for Payer: Heritage Provider Network Senior |
$136.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$1,693.68 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,693.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,693.68
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.66
|
| Rate for Payer: Heritage Provider Network Senior |
$81.09
|
| Rate for Payer: Heritage Provider Network Senior |
$112.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$62.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.70
|
| Rate for Payer: TriValley Medical Group Senior |
$40.70
|
| Rate for Payer: TriValley Medical Group Senior |
$40.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Vantage Medical Group Senior |
$40.70
|
| Rate for Payer: Vantage Medical Group Senior |
$40.70
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.21
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.21
|
| Rate for Payer: Heritage Provider Network Senior |
$123.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.94
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.64
|
| Rate for Payer: Heritage Provider Network Senior |
$260.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.25
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
|
