|
HC COLORCTL CNCR SCRN NON HGH RSK
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
900100676
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,430.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
|
|
HC COLORCTL CNCR SCRN NON HGH RSK
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
900100676
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,065.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.65
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,408.64
|
| Rate for Payer: Cigna of CA PPO |
$1,628.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,430.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLORECTAL CANCER SCRN HIGH RISK
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
900100675
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,065.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.65
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,408.64
|
| Rate for Payer: Cigna of CA PPO |
$1,628.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,430.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLORECTAL CANCER SCRN HIGH RISK
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
900100675
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,430.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
|
|
HC COLPORRHAPHY
|
Facility
|
OP
|
$8,771.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,893.90 |
| Rate for Payer: Adventist Health Commercial |
$1,754.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,016.80
|
| Rate for Payer: Cigna of CA HMO |
$5,613.44
|
| Rate for Payer: Cigna of CA PPO |
$6,490.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$7,455.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,893.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,850.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,754.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,578.25
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,701.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$7,455.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,262.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,385.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,385.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,385.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,385.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC COLPORRHAPHY
|
Facility
|
IP
|
$8,771.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,754.20 |
| Max. Negotiated Rate |
$7,893.90 |
| Rate for Payer: Adventist Health Commercial |
$1,754.20
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,016.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,508.40
|
| Rate for Payer: Galaxy Health WC |
$7,455.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,893.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,850.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,341.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,429.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,754.20
|
| Rate for Payer: Multiplan Commercial |
$6,578.25
|
| Rate for Payer: Networks By Design Commercial |
$5,701.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,455.35
|
|
|
HC COLPOSCOPY BX OF VAG/CERVIX
|
Facility
|
IP
|
$2,796.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
904057421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$2,516.40 |
| Rate for Payer: Adventist Health Commercial |
$559.20
|
| Rate for Payer: Cash Price |
$1,537.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,236.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,118.40
|
| Rate for Payer: Galaxy Health WC |
$2,376.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,677.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,516.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,864.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,730.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.20
|
| Rate for Payer: Multiplan Commercial |
$2,097.00
|
| Rate for Payer: Networks By Design Commercial |
$1,817.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,376.60
|
|
|
HC COLPOSCOPY BX OF VAG/CERVIX
|
Facility
|
OP
|
$2,796.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
904057421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.18 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$559.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,106.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,353.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,642.09
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,762.79
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,537.80
|
| Rate for Payer: Cash Price |
$1,537.80
|
| Rate for Payer: Cash Price |
$1,537.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,236.80
|
| Rate for Payer: Cigna of CA HMO |
$1,789.44
|
| Rate for Payer: Cigna of CA PPO |
$2,069.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1,106.36
|
| Rate for Payer: Galaxy Health WC |
$2,376.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,677.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,516.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,814.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$278.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: InnovAge PACE Commercial |
$1,659.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,864.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,482.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,482.52
|
| Rate for Payer: Multiplan Commercial |
$2,097.00
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: Networks By Design Commercial |
$1,817.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Preferred Health Network WC |
$1,798.77
|
| Rate for Payer: Prime Health Services Commercial |
$2,376.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,172.74
|
| Rate for Payer: Prime Health Services WC |
$1,744.81
|
| Rate for Payer: Riverside University Health System MISP |
$1,217.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,677.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC COLPOSCOPY CERV INCL UP/ADJ VAGINA W BX CERVIX
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
904000021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$241.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$585.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.05
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Central Health Plan Commercial |
$967.20
|
| Rate for Payer: Cigna of CA HMO |
$773.76
|
| Rate for Payer: Cigna of CA PPO |
$894.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,027.65
|
| Rate for Payer: Global Benefits Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,088.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$253.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$806.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$785.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,027.65
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$725.40
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY CERV INCL UP/ADJ VAGINA W BX CERVIX
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
904000021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Adventist Health Commercial |
$241.80
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Central Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$483.60
|
| Rate for Payer: Galaxy Health WC |
$1,027.65
|
| Rate for Payer: Global Benefits Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,088.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$806.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$748.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: Networks By Design Commercial |
$785.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,027.65
|
|
|
HC COLPOSCOPY/ECC
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
904000024
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Adventist Health Commercial |
$241.80
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Central Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$483.60
|
| Rate for Payer: Galaxy Health WC |
$1,027.65
|
| Rate for Payer: Global Benefits Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,088.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$806.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$748.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: Networks By Design Commercial |
$785.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,027.65
|
|
|
HC COLPOSCOPY/ECC
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
904000024
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$241.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Central Health Plan Commercial |
$967.20
|
| Rate for Payer: Cigna of CA HMO |
$773.76
|
| Rate for Payer: Cigna of CA PPO |
$894.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,027.65
|
| Rate for Payer: Global Benefits Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,088.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$806.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$785.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,027.65
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$725.40
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$465.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$615.04
|
| Rate for Payer: Cigna of CA PPO |
$711.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$234.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$615.04
|
| Rate for Payer: Cigna of CA PPO |
$711.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO |
$480.50
|
| Rate for Payer: United Healthcare HMO Rider |
$480.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$465.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$615.04
|
| Rate for Payer: Cigna of CA PPO |
$711.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$234.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.60
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Senior |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Senior |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Cash Price |
$528.55
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Senior |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC COLPOSCOPY VULVA W BIOPSY
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
904000023
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
|
|
HC COLPOSCOPY VULVA W BIOPSY
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
904000023
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$310.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.46
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: Cigna of CA HMO |
$410.24
|
| Rate for Payer: Cigna of CA PPO |
$474.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.60
|
| 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 |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY W/BIOPSY CERVIX
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
902890150
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$163.67 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$658.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,285.60
|
| Rate for Payer: Cigna of CA HMO |
$1,028.48
|
| Rate for Payer: Cigna of CA PPO |
$1,189.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,365.95
|
| Rate for Payer: Global Benefits Group Commercial |
$964.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,446.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,205.25
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$1,044.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.95
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$964.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY W/BIOPSY CERVIX
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
902890150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.16 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$321.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$981.88
|
| Rate for Payer: Blue Shield of California EPN |
$641.19
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,285.60
|
| Rate for Payer: Cigna of CA HMO |
$1,028.48
|
| Rate for Payer: Cigna of CA PPO |
$1,189.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,365.95
|
| Rate for Payer: Global Benefits Group Commercial |
$964.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,446.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,205.25
|
| Rate for Payer: Networks By Design Commercial |
$1,044.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.95
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$964.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.50
|
| Rate for Payer: United Healthcare All Other HMO |
$803.50
|
| Rate for Payer: United Healthcare HMO Rider |
$803.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$803.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY W/BIOPSY CERVIX
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
902890150
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$321.40 |
| Max. Negotiated Rate |
$1,446.30 |
| Rate for Payer: Adventist Health Commercial |
$321.40
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.80
|
| Rate for Payer: EPIC Health Plan Senior |
$642.80
|
| Rate for Payer: Galaxy Health WC |
$1,365.95
|
| Rate for Payer: Global Benefits Group Commercial |
$964.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,446.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.40
|
| Rate for Payer: Multiplan Commercial |
$1,205.25
|
| Rate for Payer: Networks By Design Commercial |
$1,044.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.95
|
|
|
HC COLPOSCOPY W/BIOPSY CERVIX
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
902890150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$321.40 |
| Max. Negotiated Rate |
$1,446.30 |
| Rate for Payer: Adventist Health Commercial |
$321.40
|
| Rate for Payer: Cash Price |
$883.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.80
|
| Rate for Payer: EPIC Health Plan Senior |
$642.80
|
| Rate for Payer: Galaxy Health WC |
$1,365.95
|
| Rate for Payer: Global Benefits Group Commercial |
$964.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,446.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.40
|
| Rate for Payer: Multiplan Commercial |
$1,205.25
|
| Rate for Payer: Networks By Design Commercial |
$1,044.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.95
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
IP
|
$10,153.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,030.60 |
| Max. Negotiated Rate |
$9,137.70 |
| Rate for Payer: Adventist Health Commercial |
$2,030.60
|
| Rate for Payer: Cash Price |
$5,584.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,061.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,061.20
|
| Rate for Payer: Galaxy Health WC |
$8,630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,091.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,137.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,772.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,868.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,284.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,030.60
|
| Rate for Payer: Multiplan Commercial |
$7,614.75
|
| Rate for Payer: Networks By Design Commercial |
$6,599.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,630.05
|
|
