|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$1,179.80 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$910.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.64
|
| Rate for Payer: Blue Shield of California Commercial |
$849.46
|
| Rate for Payer: Blue Shield of California EPN |
$560.75
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: Cigna of CA HMO |
$888.32
|
| Rate for Payer: Cigna of CA PPO |
$1,027.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$832.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$832.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cigna of CA HMO |
$847.36
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: EPIC Health Plan Senior |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$819.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: EPIC Health Plan Senior |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$819.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cigna of CA HMO |
$847.36
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
IP
|
$7,669.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,533.80 |
| Max. Negotiated Rate |
$6,518.65 |
| Rate for Payer: Adventist Health Commercial |
$1,533.80
|
| Rate for Payer: Cash Price |
$4,217.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,067.60
|
| Rate for Payer: Galaxy Health WC |
$6,518.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,601.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,921.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,747.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,840.56
|
| Rate for Payer: Multiplan Commercial |
$6,135.20
|
| Rate for Payer: Networks By Design Commercial |
$4,984.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,518.65
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
OP
|
$7,669.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,533.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,217.95
|
| Rate for Payer: Cash Price |
$4,217.95
|
| Rate for Payer: Cash Price |
$4,217.95
|
| Rate for Payer: Cigna of CA HMO |
$4,908.16
|
| Rate for Payer: Cigna of CA PPO |
$5,675.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,518.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,601.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,840.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$6,135.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,984.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,518.65
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,601.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,834.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,834.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,834.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.40 |
| Max. Negotiated Rate |
$1,399.95 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$658.80
|
| Rate for Payer: Galaxy Health WC |
$1,399.95
|
| Rate for Payer: Global Benefits Group Commercial |
$988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.28
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: Networks By Design Commercial |
$1,070.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.95
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.40 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: Cigna of CA HMO |
$1,054.08
|
| Rate for Payer: Cigna of CA PPO |
$1,218.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$1,399.95
|
| Rate for Payer: Global Benefits Group Commercial |
$988.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$1,070.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.95
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$988.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.50
|
| Rate for Payer: United Healthcare All Other HMO |
$823.50
|
| Rate for Payer: United Healthcare HMO Rider |
$823.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$823.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$2,955.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$591.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,625.25
|
| Rate for Payer: Cash Price |
$1,625.25
|
| Rate for Payer: Cash Price |
$1,625.25
|
| Rate for Payer: Cigna of CA HMO |
$1,891.20
|
| Rate for Payer: Cigna of CA PPO |
$2,186.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$2,511.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,773.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,970.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$709.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,920.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,511.75
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,773.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,477.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,477.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,477.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$2,955.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$591.00 |
| Max. Negotiated Rate |
$2,511.75 |
| Rate for Payer: Adventist Health Commercial |
$591.00
|
| Rate for Payer: Cash Price |
$1,625.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,182.00
|
| Rate for Payer: Galaxy Health WC |
$2,511.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,970.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,125.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,829.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$709.20
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: Networks By Design Commercial |
$1,920.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,511.75
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
IP
|
$6,765.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$5,750.25 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,706.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,706.00
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,577.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,187.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
OP
|
$6,765.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cash Price |
$3,720.75
|
| Rate for Payer: Cigna of CA HMO |
$4,329.60
|
| Rate for Payer: Cigna of CA PPO |
$5,006.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,059.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,382.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,382.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,382.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
OP
|
$7,386.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.23 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,477.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,062.30
|
| Rate for Payer: Cash Price |
$4,062.30
|
| Rate for Payer: Cash Price |
$4,062.30
|
| Rate for Payer: Cigna of CA HMO |
$4,727.04
|
| Rate for Payer: Cigna of CA PPO |
$5,465.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,278.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,431.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,772.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,908.80
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,800.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,278.10
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,431.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,693.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,693.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,693.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
IP
|
$7,386.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,477.20 |
| Max. Negotiated Rate |
$6,278.10 |
| Rate for Payer: Adventist Health Commercial |
$1,477.20
|
| Rate for Payer: Cash Price |
$4,062.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,954.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,954.40
|
| Rate for Payer: Galaxy Health WC |
$6,278.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,431.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,814.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,571.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,772.64
|
| Rate for Payer: Multiplan Commercial |
$5,908.80
|
| Rate for Payer: Networks By Design Commercial |
$4,800.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,278.10
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
IP
|
$8,457.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,691.40 |
| Max. Negotiated Rate |
$7,188.45 |
| Rate for Payer: Adventist Health Commercial |
$1,691.40
|
| Rate for Payer: Cash Price |
$4,651.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,382.80
|
| Rate for Payer: Galaxy Health WC |
$7,188.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,074.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,640.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,222.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,234.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,029.68
|
| Rate for Payer: Multiplan Commercial |
$6,765.60
|
| Rate for Payer: Networks By Design Commercial |
$5,497.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,188.45
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
OP
|
$8,457.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,691.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,651.35
|
| Rate for Payer: Cash Price |
$4,651.35
|
| Rate for Payer: Cash Price |
$4,651.35
|
| Rate for Payer: Cigna of CA HMO |
$5,412.48
|
| Rate for Payer: Cigna of CA PPO |
$6,258.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$7,188.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,074.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,640.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,029.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$6,765.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,497.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,188.45
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,074.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,228.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
IP
|
$10,364.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,072.80 |
| Max. Negotiated Rate |
$8,809.40 |
| Rate for Payer: Adventist Health Commercial |
$2,072.80
|
| Rate for Payer: Cash Price |
$5,700.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,415.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.36
|
| Rate for Payer: Multiplan Commercial |
$8,291.20
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
OP
|
$10,364.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.71 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,072.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,459.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,700.20
|
| Rate for Payer: Cash Price |
$5,700.20
|
| Rate for Payer: Cash Price |
$5,700.20
|
| Rate for Payer: Cigna of CA HMO |
$6,632.96
|
| Rate for Payer: Cigna of CA PPO |
$7,669.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,105.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,459.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,719.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6,459.25
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,593.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,459.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,459.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,138.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,655.40
|
| Rate for Payer: Multiplan Commercial |
$8,291.20
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,218.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,182.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,182.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,182.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,459.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6,459.25
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$311.10 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.84
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.74
|
| Rate for Payer: Blue Shield of California Commercial |
$244.85
|
| Rate for Payer: Blue Shield of California EPN |
$161.77
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.49
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.89
|
| Rate for Payer: United Healthcare HMO Rider |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$619.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.12
|
| Rate for Payer: Blue Shield of California Commercial |
$631.54
|
| Rate for Payer: Blue Shield of California EPN |
$417.25
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
