|
HC CYTOPATH-NGYN SMEAR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$239.11 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| 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 |
$239.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.11
|
| 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 |
$46.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.14
|
| Rate for Payer: Blue Shield of California Commercial |
$199.71
|
| Rate for Payer: Blue Shield of California Commercial |
$90.09
|
| Rate for Payer: Blue Shield of California EPN |
$125.85
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: Central Health Plan Commercial |
$253.60
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| 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 |
$100.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| 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 |
$269.45
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$285.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| 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 |
$44.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.41
|
| 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 |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.06
|
| 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 |
$28.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.40
|
| 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 |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| 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 |
$269.45
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| 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 |
$85.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| 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-NGYN SMEAR
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Central Health Plan Commercial |
$253.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$285.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.40
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$447.15 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.15
|
| Rate for Payer: Blue Shield of California Commercial |
$297.99
|
| Rate for Payer: Blue Shield of California EPN |
$187.78
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: Cigna of CA HMO |
$302.72
|
| Rate for Payer: Cigna of CA PPO |
$350.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$24.57
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.54
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$19.65
|
| Rate for Payer: Prime Health Services Medicare |
$19.65
|
| Rate for Payer: Riverside University Health System MISP |
$20.39
|
| Rate for Payer: Riverside University Health System MISP |
$20.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Central Health Plan Commercial |
$317.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$357.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.40
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.43
|
| Rate for Payer: Blue Shield of California Commercial |
$250.11
|
| Rate for Payer: Blue Shield of California Commercial |
$67.41
|
| Rate for Payer: Blue Shield of California EPN |
$157.61
|
| Rate for Payer: Blue Shield of California EPN |
$42.48
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Central Health Plan Commercial |
$317.60
|
| Rate for Payer: Cigna of CA HMO |
$254.08
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$293.78
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$357.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$77.56 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.91
|
| Rate for Payer: Blue Shield of California Commercial |
$60.48
|
| Rate for Payer: Blue Shield of California Commercial |
$24.57
|
| Rate for Payer: Blue Shield of California EPN |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.54
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Medicare |
$19.65
|
| Rate for Payer: Prime Health Services Medicare |
$19.65
|
| Rate for Payer: Riverside University Health System MISP |
$20.39
|
| Rate for Payer: Riverside University Health System MISP |
$20.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| 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 Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.43
|
| Rate for Payer: Blue Shield of California Commercial |
$44.73
|
| Rate for Payer: Blue Shield of California EPN |
$28.19
|
| 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: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| 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 |
$52.92
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| 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 |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| 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 |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.99
|
| Rate for Payer: Blue Shield of California Commercial |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$66.70
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.43
|
| Rate for Payer: EPIC Health Plan Senior |
$22.29
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.26
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services Medicare |
$21.48
|
| Rate for Payer: Riverside University Health System MISP |
$22.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$156.61 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.61
|
| Rate for Payer: Blue Shield of California Commercial |
$88.83
|
| Rate for Payer: Blue Shield of California EPN |
$55.98
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$90.24
|
| Rate for Payer: Cigna of CA PPO |
$104.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.02
|
| Rate for Payer: EPIC Health Plan Senior |
$25.34
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.04
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Prime Health Services Medicare |
$24.42
|
| Rate for Payer: Riverside University Health System MISP |
$25.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.67
|
| Rate for Payer: United Healthcare All Other HMO |
$18.67
|
| Rate for Payer: United Healthcare HMO Rider |
$18.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Vantage Medical Group Senior |
$23.04
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.10
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$418.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$232.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$256.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$146.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.10
|
| Rate for Payer: Vantage Medical Group Senior |
$311.10
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| 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 DACRYOCYSTOGRAM
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$1,462.69 |
| Rate for Payer: Adventist Health Commercial |
$167.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,462.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.63
|
| Rate for Payer: Blue Shield of California Commercial |
$526.05
|
| Rate for Payer: Blue Shield of California EPN |
$331.50
|
| Rate for Payer: Cash Price |
$375.75
|
| Rate for Payer: Cash Price |
$375.75
|
| Rate for Payer: Central Health Plan Commercial |
$668.00
|
| Rate for Payer: Cigna of CA HMO |
$534.40
|
| Rate for Payer: Cigna of CA PPO |
$617.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$584.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$709.75
|
| Rate for Payer: Global Benefits Group Commercial |
$501.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$530.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$626.25
|
| Rate for Payer: Networks By Design Commercial |
$542.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$709.75
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$501.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$167.00
|
| Rate for Payer: Cash Price |
$375.75
|
| Rate for Payer: Central Health Plan Commercial |
$668.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$584.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$334.00
|
| Rate for Payer: Galaxy Health WC |
$709.75
|
| Rate for Payer: Global Benefits Group Commercial |
$501.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$751.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$530.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$492.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$626.25
|
| Rate for Payer: Networks By Design Commercial |
$542.75
|
| Rate for Payer: Prime Health Services Commercial |
$709.75
|
|
|
HC DAY PROGRAM FULL DAY
|
Facility
|
IP
|
$1,199.00
|
|
| Hospital Charge Code |
905106001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$239.80 |
| Max. Negotiated Rate |
$1,079.10 |
| Rate for Payer: Adventist Health Commercial |
$239.80
|
| Rate for Payer: Cash Price |
$539.55
|
| Rate for Payer: Central Health Plan Commercial |
$959.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$839.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$479.60
|
| Rate for Payer: Galaxy Health WC |
$1,019.15
|
| Rate for Payer: Global Benefits Group Commercial |
$719.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,079.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$761.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$707.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.80
|
| Rate for Payer: Multiplan Commercial |
$899.25
|
| Rate for Payer: Networks By Design Commercial |
$779.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,019.15
|
|
|
HC DAY PROGRAM FULL DAY
|
Facility
|
OP
|
$1,199.00
|
|
| Hospital Charge Code |
905106001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,079.10 |
| Rate for Payer: Adventist Health Commercial |
$491.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$728.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,019.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$659.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$899.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$539.55
|
| Rate for Payer: Cash Price |
$539.55
|
| Rate for Payer: Central Health Plan Commercial |
$959.20
|
| Rate for Payer: Cigna of CA HMO |
$767.36
|
| Rate for Payer: Cigna of CA PPO |
$887.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,019.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,019.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,019.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$839.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$479.60
|
| Rate for Payer: Galaxy Health WC |
$1,019.15
|
| Rate for Payer: Global Benefits Group Commercial |
$719.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,079.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$761.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$707.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$839.30
|
| Rate for Payer: Multiplan Commercial |
$899.25
|
| Rate for Payer: Networks By Design Commercial |
$779.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,019.15
|
| Rate for Payer: Riverside University Health System MISP |
$479.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$719.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$719.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,019.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,019.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,019.15
|
|
|
HC DAY PROGRAM HALF DAY
|
Facility
|
OP
|
$820.00
|
|
| Hospital Charge Code |
905106000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: Cigna of CA HMO |
$524.80
|
| Rate for Payer: Cigna of CA PPO |
$606.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.00
|
| Rate for Payer: EPIC Health Plan Senior |
$328.00
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$483.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$574.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
| Rate for Payer: Riverside University Health System MISP |
$328.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.00
|
| Rate for Payer: Vantage Medical Group Senior |
$697.00
|
|
