|
HC CYTOPATH, EXTENDED STUDY
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC CYTOPATH-NGYN SMEAR
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
|
|
HC CYTOPATH-NGYN SMEAR
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$239.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$239.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.86
|
| Rate for Payer: Blue Distinction Transplant |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$94.32
|
| Rate for Payer: Blue Shield of California EPN |
$74.75
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$109.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$318.75 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$403.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.37
|
| Rate for Payer: Blue Distinction Transplant |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$242.25
|
| Rate for Payer: Blue Shield of California EPN |
$192.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$281.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.17
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$25.84
|
| Rate for Payer: Blue Shield of California EPN |
$20.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.96
|
| Rate for Payer: Dignity Health Media |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.31
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.39
|
| Rate for Payer: Heritage Provider Network Transplant |
$28.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Vantage Medical Group Senior |
$17.31
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$193.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$193.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.30
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$71.06
|
| Rate for Payer: Blue Shield of California EPN |
$56.32
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.46
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$25.84
|
| Rate for Payer: Blue Shield of California EPN |
$20.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.96
|
| Rate for Payer: Dignity Health Media |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.31
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.39
|
| Rate for Payer: Heritage Provider Network Transplant |
$28.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$28.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Vantage Medical Group Senior |
$17.31
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$193.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$193.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.30
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$46.51
|
| Rate for Payer: Blue Shield of California EPN |
$36.86
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.13
|
| Rate for Payer: Blue Distinction Transplant |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$55.56
|
| Rate for Payer: Blue Shield of California EPN |
$44.03
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$168.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$168.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.99
|
| Rate for Payer: Blue Distinction Transplant |
$103.20
|
| Rate for Payer: Blue Shield of California Commercial |
$111.11
|
| Rate for Payer: Blue Shield of California EPN |
$88.06
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Media |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.26
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$141.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.28
|
| Rate for Payer: Blue Distinction Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.02
|
| Rate for Payer: Blue Shield of California EPN |
$73.73
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.56
|
| Rate for Payer: Dignity Health Media |
$23.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.04
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$37.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$37.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.67
|
| Rate for Payer: United Healthcare All Other HMO |
$18.67
|
| Rate for Payer: United Healthcare HMO Rider |
$18.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Vantage Medical Group Senior |
$23.04
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$317.90 |
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.90
|
| Rate for Payer: Dignity Health Media |
$317.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$280.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.90
|
| Rate for Payer: Vantage Medical Group Senior |
$317.90
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$1,464.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,464.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.94
|
| Rate for Payer: Blue Distinction Transplant |
$586.80
|
| Rate for Payer: Blue Shield of California Commercial |
$578.00
|
| Rate for Payer: Blue Shield of California EPN |
$458.68
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna of CA HMO |
$625.92
|
| Rate for Payer: Cigna of CA PPO |
$723.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$733.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.72 |
| Max. Negotiated Rate |
$831.30 |
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
|
|
HC D DIMER
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.81
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Media |
$10.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$16.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
|
OP
|
$12,690.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.18 |
| Max. Negotiated Rate |
$10,786.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,614.00
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cigna of CA PPO |
$9,390.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$10,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,614.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,517.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,045.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
| Rate for Payer: Networks By Design Commercial |
$8,248.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,786.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,614.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,345.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,345.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,345.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
