|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$4,463.10 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,967.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,471.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,983.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,983.60
|
| Rate for Payer: Galaxy Health WC |
$4,215.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,975.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,463.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,148.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,925.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.80
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Networks By Design Commercial |
$3,223.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,215.15
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
OP
|
$11,347.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$10,212.30 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,077.60
|
| Rate for Payer: Cigna of CA HMO |
$7,262.08
|
| Rate for Payer: Cigna of CA PPO |
$8,396.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,942.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$9,644.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,212.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,205.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$7,375.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$9,644.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,808.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,673.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,673.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,673.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,673.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
IP
|
$11,347.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,269.40 |
| Max. Negotiated Rate |
$10,212.30 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,077.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,942.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,538.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,538.80
|
| Rate for Payer: Galaxy Health WC |
$9,644.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,212.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,205.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,694.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.40
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
| Rate for Payer: Networks By Design Commercial |
$7,375.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,644.95
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
OP
|
$12,389.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,150.10 |
| Rate for Payer: Adventist Health Commercial |
$2,477.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$5,575.05
|
| Rate for Payer: Cash Price |
$5,575.05
|
| Rate for Payer: Cash Price |
$5,575.05
|
| Rate for Payer: Cash Price |
$5,575.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,911.20
|
| Rate for Payer: Cigna of CA HMO |
$7,928.96
|
| Rate for Payer: Cigna of CA PPO |
$9,167.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,672.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$10,530.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,433.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,150.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,867.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$9,291.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$8,052.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$10,530.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,433.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,194.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,194.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,194.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,194.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
IP
|
$12,389.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,477.80 |
| Max. Negotiated Rate |
$11,150.10 |
| Rate for Payer: Adventist Health Commercial |
$2,477.80
|
| Rate for Payer: Cash Price |
$5,575.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,911.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,672.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,955.60
|
| Rate for Payer: Galaxy Health WC |
$10,530.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,433.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,150.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,867.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,309.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.80
|
| Rate for Payer: Multiplan Commercial |
$9,291.75
|
| Rate for Payer: Networks By Design Commercial |
$8,052.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,530.65
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
IP
|
$14,185.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,837.00 |
| Max. Negotiated Rate |
$12,766.50 |
| Rate for Payer: Adventist Health Commercial |
$2,837.00
|
| Rate for Payer: Cash Price |
$6,383.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,348.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,929.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,674.00
|
| Rate for Payer: Galaxy Health WC |
$12,057.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,511.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,766.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,007.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,369.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.00
|
| Rate for Payer: Multiplan Commercial |
$10,638.75
|
| Rate for Payer: Networks By Design Commercial |
$9,220.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,057.25
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
OP
|
$14,185.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$12,766.50 |
| Rate for Payer: Adventist Health Commercial |
$2,837.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$6,383.25
|
| Rate for Payer: Cash Price |
$6,383.25
|
| Rate for Payer: Cash Price |
$6,383.25
|
| Rate for Payer: Cash Price |
$6,383.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,348.00
|
| Rate for Payer: Cigna of CA HMO |
$9,078.40
|
| Rate for Payer: Cigna of CA PPO |
$10,496.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,929.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$12,057.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,511.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,766.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,007.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$10,638.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$9,220.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$12,057.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,511.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,092.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,092.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,092.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,092.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
OP
|
$17,383.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,644.70 |
| Rate for Payer: Adventist Health Commercial |
$3,476.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,291.67
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Central Health Plan Commercial |
$13,906.40
|
| Rate for Payer: Cigna of CA HMO |
$11,125.12
|
| Rate for Payer: Cigna of CA PPO |
$12,863.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,168.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,378.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7,585.79
|
| Rate for Payer: Galaxy Health WC |
$14,775.55
|
| Rate for Payer: Global Benefits Group Commercial |
$10,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,644.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,309.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,038.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,413.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,476.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan Commercial |
$13,037.25
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: Networks By Design Commercial |
$11,298.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Preferred Health Network WC |
$10,501.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,775.55
|
| Rate for Payer: Prime Health Services Medicare |
$7,309.94
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Riverside University Health System MISP |
$7,585.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,691.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,691.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,691.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,896.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
IP
|
$17,383.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,476.60 |
| Max. Negotiated Rate |
$15,644.70 |
| Rate for Payer: Adventist Health Commercial |
$3,476.60
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Central Health Plan Commercial |
$13,906.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,168.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,953.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,953.20
|
| Rate for Payer: Galaxy Health WC |
$14,775.55
|
| Rate for Payer: Global Benefits Group Commercial |
$10,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,644.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,038.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,255.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,476.60
|
| Rate for Payer: Multiplan Commercial |
$13,037.25
|
| Rate for Payer: Networks By Design Commercial |
$11,298.95
|
| Rate for Payer: Prime Health Services Commercial |
$14,775.55
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$361.55 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$230.58
|
| Rate for Payer: Blue Shield of California Commercial |
$65.52
|
| Rate for Payer: Blue Shield of California EPN |
$145.30
|
| Rate for Payer: Blue Shield of California EPN |
$41.29
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$232.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$232.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$45.55 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.55
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Riverside University Health System MISP |
$10.40
|
| Rate for Payer: Riverside University Health System MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.89
|
| Rate for Payer: United Healthcare HMO Rider |
$5.89
|
| Rate for Payer: United Healthcare HMO Rider |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22.10
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.72
|
| Rate for Payer: Blue Shield of California Commercial |
$49.14
|
| Rate for Payer: Blue Shield of California EPN |
$374.77
|
| Rate for Payer: Blue Shield of California EPN |
$30.97
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$599.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: EPIC Health Plan Senior |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$599.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.52
|
| Rate for Payer: Blue Shield of California Commercial |
$185.22
|
| Rate for Payer: Blue Shield of California Commercial |
$44.73
|
| Rate for Payer: Blue Shield of California EPN |
$116.72
|
| Rate for Payer: Blue Shield of California EPN |
$28.19
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| 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 Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Riverside University Health System MISP |
$28.40
|
| Rate for Payer: Riverside University Health System MISP |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$197.19
|
| Rate for Payer: Blue Shield of California Commercial |
$167.58
|
| Rate for Payer: Blue Shield of California EPN |
$124.26
|
| Rate for Payer: Blue Shield of California EPN |
$105.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: Cigna of CA HMO |
$200.32
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$231.62
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
|
HC CYTOPATH CONCENTRATION, PG
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800210
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC CYTOPATH CONCENTRATION, PG
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800210
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.11
|
| 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 Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.66
|
| Rate for Payer: Blue Shield of California Commercial |
$66.15
|
| Rate for Payer: Blue Shield of California EPN |
$41.69
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| 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 |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| 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 |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| 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-CONCENTRATION TECH
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| 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 Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.66
|
| Rate for Payer: Blue Shield of California Commercial |
$312.48
|
| Rate for Payer: Blue Shield of California Commercial |
$67.41
|
| Rate for Payer: Blue Shield of California EPN |
$196.91
|
| Rate for Payer: Blue Shield of California EPN |
$42.48
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Central Health Plan Commercial |
$396.80
|
| Rate for Payer: Cigna of CA HMO |
$317.44
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$367.04
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$347.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$446.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$314.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$297.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$297.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| 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 All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| 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 Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Central Health Plan Commercial |
$396.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$347.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Senior |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$314.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$292.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.20
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
|
|
HC CYTOPATH, EXTENDED STUDY
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Central Health Plan Commercial |
$191.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.60
|
| Rate for Payer: EPIC Health Plan Senior |
$95.60
|
| Rate for Payer: Galaxy Health WC |
$203.15
|
| Rate for Payer: Global Benefits Group Commercial |
$143.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| Rate for Payer: Networks By Design Commercial |
$155.35
|
| Rate for Payer: Prime Health Services Commercial |
$203.15
|
|
|
HC CYTOPATH, EXTENDED STUDY
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$260.71 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| 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 Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.31
|
| Rate for Payer: Blue Shield of California Commercial |
$150.57
|
| Rate for Payer: Blue Shield of California Commercial |
$67.41
|
| Rate for Payer: Blue Shield of California EPN |
$94.88
|
| Rate for Payer: Blue Shield of California EPN |
$42.48
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Central Health Plan Commercial |
$191.20
|
| Rate for Payer: Cigna of CA HMO |
$152.96
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$176.86
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$203.15
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$143.40
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Networks By Design Commercial |
$155.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$203.15
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| 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 All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| 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 Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
