|
HC SOM FIAIA 82397
|
Facility
|
IP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Adventist Health Commercial |
$37.25
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.09
|
| Rate for Payer: Heritage Provider Network Senior |
$126.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$139.69
|
|
|
HC SOM FIAIA 82397
|
Facility
|
OP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Adventist Health Commercial |
$37.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$99.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.01
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$91.20
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$139.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
|
OP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$1,132.59 |
| Rate for Payer: Adventist Health Commercial |
$38.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.38
|
| Rate for Payer: Heritage Provider Network Senior |
$120.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$145.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
|
IP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Adventist Health Commercial |
$38.90
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.66
|
| Rate for Payer: Heritage Provider Network Senior |
$131.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.62
|
| Rate for Payer: Multiplan Commercial |
$145.86
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.67
|
| Rate for Payer: Blue Shield of California Commercial |
$36.92
|
| Rate for Payer: Blue Shield of California EPN |
$29.61
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Senior |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.64
|
| Rate for Payer: Heritage Provider Network Senior |
$8.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.47
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.07
|
| Rate for Payer: TriValley Medical Group Senior |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.44
|
| Rate for Payer: Heritage Provider Network Senior |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
|
|
HC SOM FIDQL 86331
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$109.40 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.40
|
| Rate for Payer: Blue Shield of California Commercial |
$96.48
|
| Rate for Payer: Blue Shield of California EPN |
$77.39
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FIDQL 86331
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.94
|
| Rate for Payer: Heritage Provider Network Senior |
$39.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
|
|
HC SOM FINA 86382
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC SOM FINA 86382
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$210.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.41
|
| Rate for Payer: Blue Shield of California Commercial |
$136.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.12
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$255.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.60
|
| Rate for Payer: Dignity Health Senior |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.27
|
| Rate for Payer: Heritage Provider Network Senior |
$243.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$187.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.31
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.91
|
| Rate for Payer: TriValley Medical Group Senior |
$16.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Vantage Medical Group Senior |
$16.91
|
|
|
HC SOM FINA 87253
|
Facility
|
IP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$84.93 |
| Max. Negotiated Rate |
$351.92 |
| Rate for Payer: Adventist Health Commercial |
$93.85
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$317.67
|
| Rate for Payer: Heritage Provider Network Senior |
$317.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.31
|
| Rate for Payer: Multiplan Commercial |
$351.92
|
|
|
HC SOM FINA 87253
|
Facility
|
OP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$351.92 |
| Rate for Payer: Adventist Health Commercial |
$93.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$250.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$322.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.50
|
| Rate for Payer: Blue Shield of California Commercial |
$73.84
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$305.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.22
|
| Rate for Payer: Dignity Health Senior |
$20.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.45
|
| Rate for Payer: Heritage Provider Network Senior |
$290.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$223.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$351.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.20
|
| Rate for Payer: TriValley Medical Group Senior |
$20.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Vantage Medical Group Senior |
$20.20
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH B ALL
|
Facility
|
IP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$127.72 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.58
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
|
|
HC SOM FISH B ALL
|
Facility
|
OP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.75
|
| Rate for Payer: Dignity Health Senior |
$144.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.42
|
| Rate for Payer: Heritage Provider Network Senior |
$105.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.75
|
| Rate for Payer: Vantage Medical Group Senior |
$144.75
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Senior |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Senior |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Senior |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.73 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
