|
HC SOM CHRBM CULTURE 04
|
Facility
IP
|
$102.19
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.20
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.18
|
| Rate for Payer: Heritage Provider Network Senior |
$69.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.55
|
| Rate for Payer: Multiplan Commercial |
$76.64
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
OP
|
$91.49
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$909.88 |
| Rate for Payer: Adventist Health Commercial |
$18.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.85
|
| Rate for Payer: Blue Shield of California Commercial |
$909.88
|
| Rate for Payer: Blue Shield of California EPN |
$711.30
|
| Rate for Payer: Cash Price |
$41.17
|
| Rate for Payer: Cash Price |
$41.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.63
|
| Rate for Payer: Heritage Provider Network Senior |
$56.63
|
| Rate for Payer: Humana Medicare |
$116.49
|
| Rate for Payer: IEHP Medi-Cal |
$157.53
|
| Rate for Payer: IEHP Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$221.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.78
|
| Rate for Payer: Multiplan Commercial |
$68.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
IP
|
$91.49
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$68.62 |
| Rate for Payer: Adventist Health Commercial |
$18.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.85
|
| Rate for Payer: Cash Price |
$41.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.94
|
| Rate for Payer: Heritage Provider Network Senior |
$61.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.87
|
| Rate for Payer: Multiplan Commercial |
$68.62
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
OP
|
$360.93
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.33 |
| Max. Negotiated Rate |
$1,150.09 |
| Rate for Payer: Adventist Health Commercial |
$72.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$428.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.09
|
| Rate for Payer: Blue Shield of California EPN |
$899.08
|
| Rate for Payer: Cash Price |
$162.42
|
| Rate for Payer: Cash Price |
$162.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.42
|
| Rate for Payer: Heritage Provider Network Senior |
$223.42
|
| Rate for Payer: Humana Medicare |
$150.30
|
| Rate for Payer: IEHP Medi-Cal |
$117.05
|
| Rate for Payer: IEHP Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.38
|
| Rate for Payer: Multiplan Commercial |
$270.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
IP
|
$360.93
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.33 |
| Max. Negotiated Rate |
$270.70 |
| Rate for Payer: Adventist Health Commercial |
$72.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.96
|
| Rate for Payer: Cash Price |
$162.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.35
|
| Rate for Payer: Heritage Provider Network Senior |
$244.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.23
|
| Rate for Payer: Multiplan Commercial |
$270.70
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
OP
|
$159.82
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$986.47 |
| Rate for Payer: Adventist Health Commercial |
$31.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$367.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$897.50
|
| Rate for Payer: Blue Shield of California Commercial |
$986.47
|
| Rate for Payer: Blue Shield of California EPN |
$771.17
|
| Rate for Payer: Cash Price |
$71.92
|
| Rate for Payer: Cash Price |
$71.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$103.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Senior |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$143.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.93
|
| Rate for Payer: Heritage Provider Network Senior |
$98.93
|
| Rate for Payer: Humana Medicare |
$143.75
|
| Rate for Payer: IEHP Medi-Cal |
$155.44
|
| Rate for Payer: IEHP Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$119.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.75
|
| Rate for Payer: TriValley Medical Group Senior |
$143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$155.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
IP
|
$159.82
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$119.86 |
| Rate for Payer: Adventist Health Commercial |
$31.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.80
|
| Rate for Payer: Cash Price |
$71.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.20
|
| Rate for Payer: Heritage Provider Network Senior |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.96
|
| Rate for Payer: Multiplan Commercial |
$119.86
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
IP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$133.83 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.59
|
| Rate for Payer: Cash Price |
$80.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.80
|
| Rate for Payer: Heritage Provider Network Senior |
$120.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.61
|
| Rate for Payer: Multiplan Commercial |
$133.83
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
OP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$1,194.87 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$429.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,194.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,152.21
|
| Rate for Payer: Blue Shield of California EPN |
$900.74
|
| Rate for Payer: Cash Price |
$80.30
|
| Rate for Payer: Cash Price |
$80.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.45
|
| Rate for Payer: Heritage Provider Network Senior |
$110.45
|
| Rate for Payer: Humana Medicare |
$147.52
|
| Rate for Payer: IEHP Medi-Cal |
$204.55
|
| Rate for Payer: IEHP Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.88
|
| Rate for Payer: Multiplan Commercial |
$133.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CHROMIUM
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$169.73 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.73
|
| Rate for Payer: Blue Shield of California Commercial |
$158.42
|
| Rate for Payer: Blue Shield of California EPN |
$123.85
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Senior |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$20.28
|
| Rate for Payer: IEHP Medi-Cal |
$28.13
|
| Rate for Payer: IEHP Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.55
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.28
|
| Rate for Payer: TriValley Medical Group Senior |
$20.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
|
HC SOM CHROMIUM
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM CHROMIUM URINE
|
Facility
OP
|
$27.57
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$169.73 |
| Rate for Payer: Adventist Health Commercial |
$5.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.73
|
| Rate for Payer: Blue Shield of California Commercial |
$158.42
|
| Rate for Payer: Blue Shield of California EPN |
$123.85
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Senior |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.07
|
| Rate for Payer: Heritage Provider Network Senior |
$17.07
|
| Rate for Payer: Humana Medicare |
$20.28
|
| Rate for Payer: IEHP Medi-Cal |
$28.13
|
| Rate for Payer: IEHP Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.55
|
| Rate for Payer: Multiplan Commercial |
$20.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.28
|
| Rate for Payer: TriValley Medical Group Senior |
$20.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
|
HC SOM CHROMIUM URINE
|
Facility
IP
|
$27.57
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Adventist Health Commercial |
$5.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.94
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Senior |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$20.68
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
OP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$174.18 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.18
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.93
|
| Rate for Payer: Heritage Provider Network Senior |
$10.93
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: IEHP Medi-Cal |
$28.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM CHROMOGRANIN A
|
Facility
IP
|
$17.65
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900911458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.13
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.95
|
| Rate for Payer: Heritage Provider Network Senior |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$13.24
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
IP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
|
|
HC SOM CHROMOSOMAL MICROARRAY
|
Facility
OP
|
$950.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$98.67 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$446.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.67
|
| Rate for Payer: Blue Shield of California Commercial |
$589.95
|
| Rate for Payer: Blue Shield of California EPN |
$557.65
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,276.00
|
| Rate for Payer: Dignity Health Senior |
$1,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.05
|
| Rate for Payer: Heritage Provider Network Senior |
$588.05
|
| Rate for Payer: Humana Medicare |
$1,160.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,204.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,368.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,461.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,160.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,160.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,252.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,252.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,160.00
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
IP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$182.33 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.02
|
| Rate for Payer: Cash Price |
$109.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.59
|
| Rate for Payer: Heritage Provider Network Senior |
$164.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.78
|
| Rate for Payer: Multiplan Commercial |
$182.33
|
|
|
HC SOM CHROMOSOME ANALYSIS BREAKAGE
|
Facility
OP
|
$243.11
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912554
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$182.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$150.97
|
| Rate for Payer: Blue Shield of California EPN |
$142.71
|
| Rate for Payer: Cash Price |
$109.40
|
| Rate for Payer: Cash Price |
$109.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.64
|
| Rate for Payer: Dignity Health Senior |
$206.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.49
|
| Rate for Payer: Heritage Provider Network Senior |
$150.49
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.78
|
| Rate for Payer: Multiplan Commercial |
$182.33
|
| 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 Medi-Cal |
$206.64
|
| Rate for Payer: Vantage Medical Group Senior |
$206.64
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
IP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
|
|
HC SOM CHROMOSOME ANALYSIS MARROW
|
Facility
OP
|
$950.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$522.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$712.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$589.95
|
| Rate for Payer: Blue Shield of California EPN |
$557.65
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$807.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$807.50
|
| Rate for Payer: Dignity Health Senior |
$807.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.05
|
| Rate for Payer: Heritage Provider Network Senior |
$588.05
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$457.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
| 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 Medi-Cal |
$807.50
|
| Rate for Payer: Vantage Medical Group Senior |
$807.50
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.77 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$268.62
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.71
|
| Rate for Payer: Heritage Provider Network Senior |
$264.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.75
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$268.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$242.81
|
| Rate for Payer: Blue Shield of California EPN |
$229.52
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Senior |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.03
|
| Rate for Payer: Heritage Provider Network Senior |
$242.03
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.75
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| 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 Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.37
|
| Rate for Payer: Blue Shield of California Commercial |
$248.40
|
| Rate for Payer: Blue Shield of California EPN |
$234.80
|
| 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: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Senior |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$192.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| 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 Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.80
|
| Rate for Payer: Heritage Provider Network Senior |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
|
