|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$402.05 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.52
|
| Rate for Payer: Multiplan Commercial |
$378.40
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$456.33 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$456.33
|
| Rate for Payer: Blue Shield of California Commercial |
$218.05
|
| Rate for Payer: Blue Shield of California Commercial |
$329.68
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cigna of CA HMO |
$302.72
|
| Rate for Payer: Cigna of CA PPO |
$350.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$378.40
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.80
|
| 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: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| 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 All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$219.48 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| 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 Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.51
|
| Rate for Payer: Blue Shield of California Commercial |
$183.02
|
| Rate for Payer: Blue Shield of California Commercial |
$49.33
|
| Rate for Payer: Blue Shield of California Commercial |
$276.71
|
| Rate for Payer: Blue Shield of California Commercial |
$74.58
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$254.08
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Cigna of CA PPO |
$293.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| 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 All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| 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 Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.27
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$17.98
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| 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 All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$219.48 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.48
|
| 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 |
$53.51
|
| Rate for Payer: Blue Shield of California Commercial |
$32.73
|
| Rate for Payer: Blue Shield of California Commercial |
$49.49
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| 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 |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| 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: Upland Medical Group Pediatric |
$37.20
|
| 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 PG
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$346.85 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$346.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.03
|
| Rate for Payer: Blue Shield of California Commercial |
$38.72
|
| Rate for Payer: Blue Shield of California Commercial |
$58.55
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| 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: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
OP
|
$168.00
|
|
|
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: Adventist Health Commercial |
$33.60
|
| 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 |
$145.93
|
| Rate for Payer: Blue Shield of California Commercial |
$117.10
|
| Rate for Payer: Blue Shield of California Commercial |
$77.45
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.43
|
| Rate for Payer: EPIC Health Plan Senior |
$22.29
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| 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 |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| 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: Upland Medical Group Pediatric |
$20.26
|
| 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
|
$168.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$159.82 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| 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 |
$159.82
|
| Rate for Payer: Blue Shield of California Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO |
$90.24
|
| Rate for Payer: Cigna of CA PPO |
$104.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.02
|
| Rate for Payer: EPIC Health Plan Senior |
$25.34
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.84
|
| 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 |
$112.80
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| 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: Upland Medical Group Pediatric |
$23.04
|
| 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
|
$141.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO |
$203.52
|
| Rate for Payer: Cigna of CA PPO |
$235.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$127.20
|
| Rate for Payer: Galaxy Health WC |
$270.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Networks By Design Commercial |
$206.70
|
| Rate for Payer: Prime Health Services Commercial |
$270.30
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.71 |
| Max. Negotiated Rate |
$1,657.33 |
| Rate for Payer: Cigna of CA PPO |
$680.06
|
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,657.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.23
|
| Rate for Payer: Blue Shield of California Commercial |
$386.90
|
| Rate for Payer: Blue Shield of California Commercial |
$586.32
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cigna of CA HMO |
$588.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$583.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$551.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$551.40
|
| 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: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$781.15 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$583.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$542.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.56
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
|
IP
|
$7,124.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,424.80 |
| Max. Negotiated Rate |
$6,055.40 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,986.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,849.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,849.60
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,523.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,203.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
|
OP
|
$7,124.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$665.55 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,499.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna of CA HMO |
$4,559.36
|
| Rate for Payer: Cigna of CA PPO |
$5,271.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,986.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$665.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,523.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$752.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
|
OP
|
$7,124.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,493.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Cigna of CA HMO |
$4,559.36
|
| Rate for Payer: Cigna of CA PPO |
$5,271.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,986.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,523.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
|
IP
|
$7,124.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,424.80 |
| Max. Negotiated Rate |
$6,055.40 |
| Rate for Payer: Adventist Health Commercial |
$1,424.80
|
| Rate for Payer: Cash Price |
$3,205.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,986.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,849.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,849.60
|
| Rate for Payer: Galaxy Health WC |
$6,055.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,274.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,523.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,203.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,709.76
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Networks By Design Commercial |
$4,630.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,055.40
|
|
|
HC DCMPRSN PERC W PRTL RMV OF LF INCL LMNTY
|
Facility
|
IP
|
$23,332.00
|
|
|
Service Code
|
CPT 62330
|
| Hospital Charge Code |
906811875
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,666.40 |
| Max. Negotiated Rate |
$19,832.20 |
| Rate for Payer: Adventist Health Commercial |
$4,666.40
|
| Rate for Payer: Cash Price |
$10,499.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,332.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,332.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,332.80
|
| Rate for Payer: Galaxy Health WC |
$19,832.20
|
| Rate for Payer: Global Benefits Group Commercial |
$13,999.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,815.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,765.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,599.68
|
| Rate for Payer: Multiplan Commercial |
$18,665.60
|
| Rate for Payer: Networks By Design Commercial |
$15,165.80
|
| Rate for Payer: Prime Health Services Commercial |
$19,832.20
|
|
