|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
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 |
$2,727.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,967.20
|
| 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 Permanente of CA Commercial/Self Funded |
$3,307.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,889.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,069.62
|
| 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
|
Facility
|
OP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$4,463.10 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,967.20
|
| Rate for Payer: Cigna of CA HMO |
$3,173.76
|
| Rate for Payer: Cigna of CA PPO |
$3,669.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$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: Heritage Provider Network Commercial/Senior |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,307.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$3,223.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$848.09
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$4,215.15
|
| Rate for Payer: Prime Health Services Medicare |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,975.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,479.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,479.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,479.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC CYSTOURETHROSCOPY, 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 |
$6,240.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,077.60
|
| 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 Permanente of CA Commercial/Self Funded |
$7,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,323.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,023.79
|
| 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/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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$6,240.85
|
| Rate for Payer: Cash Price |
$6,240.85
|
| Rate for Payer: Cash Price |
$6,240.85
|
| Rate for Payer: Cash Price |
$6,240.85
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
OP
|
$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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$6,813.95
|
| Rate for Payer: Cash Price |
$6,813.95
|
| Rate for Payer: Cash Price |
$6,813.95
|
| Rate for Payer: Cash Price |
$6,813.95
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,263.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
IP
|
$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 |
$6,813.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,911.20
|
| 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 Permanente of CA Commercial/Self Funded |
$8,263.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,720.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,668.79
|
| 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
|
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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$7,801.75
|
| Rate for Payer: Cash Price |
$7,801.75
|
| Rate for Payer: Cash Price |
$7,801.75
|
| Rate for Payer: Cash Price |
$7,801.75
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,461.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY,W/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 |
$7,801.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,348.00
|
| 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 Permanente of CA Commercial/Self Funded |
$9,461.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,404.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,780.51
|
| 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 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 |
$9,560.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,906.40
|
| 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 Permanente of CA Commercial/Self Funded |
$11,594.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,622.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,760.08
|
| 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 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 |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,459.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,291.67
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Cash Price |
$9,560.65
|
| 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 |
$9,688.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,105.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,459.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,719.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6,459.25
|
| Rate for Payer: Galaxy Health WC |
$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 |
$10,593.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,459.25
|
| Rate for Payer: InnovAge PACE Commercial |
$9,688.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,594.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,459.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,476.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,655.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,655.40
|
| 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 |
$6,459.25
|
| 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 |
$6,846.81
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Riverside University Health System MISP |
$7,105.18
|
| 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 |
$6,459.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6,459.25
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.36
|
| Rate for Payer: Blue Shield of California Commercial |
$63.13
|
| Rate for Payer: Blue Shield of California EPN |
$41.29
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| 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 HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
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 |
$41.31 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.30
|
| 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 HMO/PPO |
$6.65
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| 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: InnovAge PACE Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Riverside University Health System MISP |
$10.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.89
|
| Rate for Payer: United Healthcare HMO Rider |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Vantage Medical Group Senior |
$22.10
|
|
|
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 |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.23
|
| Rate for Payer: Blue Shield of California Commercial |
$47.35
|
| Rate for Payer: Blue Shield of California EPN |
$30.97
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| 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 HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
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 |
$94.39 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| 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 HMO/PPO |
$14.82
|
| Rate for Payer: Blue Shield of California Commercial |
$43.10
|
| Rate for Payer: Blue Shield of California EPN |
$28.19
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Cash Price |
$39.05
|
| 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 |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$85.45
|
| Rate for Payer: InnovAge PACE Commercial |
$35.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.70
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$28.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$15.70
|
| 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 Senior |
$60.35
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
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 |
$39.05
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| 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 Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.95
|
| 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 CYTOMEG DNA QUANT
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
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 |
$239.40 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.54
|
| 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 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 HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$161.46
|
| Rate for Payer: Blue Shield of California EPN |
$105.60
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| 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) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| 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 HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| 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 Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
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 |
$57.75
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| 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 Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| 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 |
$9.73 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$63.73
|
| Rate for Payer: Blue Shield of California EPN |
$41.69
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| 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 |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| 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 |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| 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 |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| 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 |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
