|
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 |
$1,355.40 |
| Rate for Payer: EPIC Health Plan Commercial |
$115.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,355.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.25
|
| Rate for Payer: Blue Shield of California EPN |
$952.27
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cash Price |
$178.44
|
| 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 Medicare Advantage |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.45
|
| Rate for Payer: Heritage Provider Network Senior |
$110.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| 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
|
IP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.81
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.68
|
| Rate for Payer: Heritage Provider Network Senior |
$17.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
|
|
HC SOM CHROMIUM
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$192.53 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.53
|
| Rate for Payer: Blue Shield of California Commercial |
$163.24
|
| Rate for Payer: Blue Shield of California EPN |
$130.93
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.16
|
| Rate for Payer: Heritage Provider Network Senior |
$16.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| 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
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.81
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.68
|
| Rate for Payer: Heritage Provider Network Senior |
$17.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
|
|
HC SOM CHROMIUM URINE
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900910731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$192.53 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.53
|
| Rate for Payer: Blue Shield of California Commercial |
$163.24
|
| Rate for Payer: Blue Shield of California EPN |
$130.93
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.16
|
| Rate for Payer: Heritage Provider Network Senior |
$16.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| 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 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 |
$197.58 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.58
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| 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 |
$31.21
|
| 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 |
$11.37
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.95
|
| Rate for Payer: Heritage Provider Network Senior |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$1,728.62
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Adventist Health Commercial |
$345.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,068.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,276.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,054.46
|
| Rate for Payer: Blue Shield of California EPN |
$843.57
|
| Rate for Payer: Cash Price |
$1,728.62
|
| Rate for Payer: Cash Price |
$1,728.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,123.60
|
| 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 Medicare Advantage |
$1,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,070.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,070.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$824.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$312.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,334.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,554.40
|
| Rate for Payer: Multiplan Commercial |
$1,296.46
|
| 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 CHROMOSOMAL MICROARRAY
|
Facility
|
IP
|
$1,728.62
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
900914668
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$312.88 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Adventist Health Commercial |
$345.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,113.23
|
| Rate for Payer: Cash Price |
$1,728.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,170.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,170.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$312.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.15
|
| Rate for Payer: Multiplan Commercial |
$1,296.46
|
|
|
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 |
$156.56
|
| Rate for Payer: Cash Price |
$243.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.59
|
| Rate for Payer: Heritage Provider Network Senior |
$164.59
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$29.95 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Adventist Health Commercial |
$48.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| 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 |
$243.11
|
| Rate for Payer: Cash Price |
$243.11
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$115.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.18
|
| 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 Commercial/Exchange |
$206.64
|
| 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 |
$611.80
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$29.95 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$587.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$807.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$522.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$712.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| 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 |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$453.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$665.00
|
| 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 Commercial/Exchange |
$807.50
|
| 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
|
OP
|
$315.45
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$268.13 |
| Rate for Payer: Adventist Health Commercial |
$63.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$268.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| 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 |
$315.45
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$268.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$268.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$268.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$195.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$220.81
|
| Rate for Payer: Multiplan Commercial |
$236.59
|
| 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 |
$268.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$268.13
|
| Rate for Payer: Vantage Medical Group Senior |
$268.13
|
|
|
HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD
|
Facility
|
IP
|
$315.45
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910752
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$236.59 |
| Rate for Payer: Adventist Health Commercial |
$63.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$203.15
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.56
|
| Rate for Payer: Heritage Provider Network Senior |
$213.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.86
|
| Rate for Payer: Multiplan Commercial |
$236.59
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
OP
|
$308.52
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$262.24 |
| Rate for Payer: Adventist Health Commercial |
$61.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| 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 |
$308.52
|
| Rate for Payer: Cash Price |
$308.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.97
|
| Rate for Payer: Heritage Provider Network Senior |
$190.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$147.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$215.96
|
| Rate for Payer: Multiplan Commercial |
$231.39
|
| 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 |
$262.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.24
|
| Rate for Payer: Vantage Medical Group Senior |
$262.24
|
|
|
HC SOM CHROMOSOMES CHORIONIC VILLUS
|
Facility
|
IP
|
$308.52
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912549
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$231.39 |
| Rate for Payer: Adventist Health Commercial |
$61.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.69
|
| Rate for Payer: Cash Price |
$308.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.87
|
| Rate for Payer: Heritage Provider Network Senior |
$208.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.13
|
| Rate for Payer: Multiplan Commercial |
$231.39
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
OP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| 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 |
$36.56
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.63
|
| Rate for Payer: Heritage Provider Network Senior |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.59
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| 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 |
$31.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.08
|
| Rate for Payer: Vantage Medical Group Senior |
$31.08
|
|
|
HC SOM CHROMOSOMES LYMPHOID
|
Facility
|
IP
|
$36.56
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912548
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$27.42 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.54
|
| Rate for Payer: Cash Price |
$36.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.75
|
| Rate for Payer: Heritage Provider Network Senior |
$24.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$67.88 |
| Rate for Payer: Adventist Health Commercial |
$18.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.28
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.27
|
| Rate for Payer: Heritage Provider Network Senior |
$61.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$67.88
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Adventist Health Commercial |
$18.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.38
|
| 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 |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.02
|
| Rate for Payer: Heritage Provider Network Senior |
$56.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.35
|
| Rate for Payer: Multiplan Commercial |
$67.88
|
| 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 |
$76.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.92
|
| Rate for Payer: Vantage Medical Group Senior |
$76.92
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
|
OP
|
$385.50
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.78 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.24
|
| 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 |
$1,134.30
|
| 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 |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$250.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.62
|
| Rate for Payer: Heritage Provider Network Senior |
$238.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$183.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$289.12
|
| 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 CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
|
IP
|
$385.50
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.78 |
| Max. Negotiated Rate |
$289.12 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$248.26
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.98
|
| Rate for Payer: Heritage Provider Network Senior |
$260.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.38
|
| Rate for Payer: Multiplan Commercial |
$289.12
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.04
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.48
|
| Rate for Payer: Blue Shield of California Commercial |
$100.28
|
| Rate for Payer: Blue Shield of California EPN |
$80.43
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.46
|
| Rate for Payer: TriValley Medical Group Senior |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
