|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
OP
|
$14,760.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,284.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,856.00
|
| Rate for Payer: Caremore Medicare Advantage |
$6,465.01
|
| Rate for Payer: Cash Price |
$6,642.00
|
| Rate for Payer: Cash Price |
$6,642.00
|
| Rate for Payer: Cash Price |
$6,642.00
|
| Rate for Payer: Cash Price |
$6,642.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,808.00
|
| Rate for Payer: Cigna of CA PPO |
$10,922.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$12,546.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,856.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,284.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,070.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,602.62
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Innovage PACE Commercial |
$9,697.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,844.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,952.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,663.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$11,070.00
|
| Rate for Payer: Networks By Design Commercial |
$9,594.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,546.00
|
| Rate for Payer: Prime Health Services Medicare |
$6,852.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,856.00
|
| Rate for Payer: Riverside University Health MISP |
$7,111.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,856.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,380.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,380.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,380.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,380.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
IP
|
$14,760.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,952.00 |
| Max. Negotiated Rate |
$13,284.00 |
| Rate for Payer: Cash Price |
$6,642.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,808.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,904.00
|
| Rate for Payer: Galaxy Health WC |
$12,546.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,856.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,284.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,844.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,952.00
|
| Rate for Payer: Multiplan Commercial |
$11,070.00
|
| Rate for Payer: Networks By Design Commercial |
$9,594.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,546.00
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$12,338.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.30
|
| Rate for Payer: BCBS Transplant Transplant |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$65.51
|
| Rate for Payer: Blue Shield of California EPN |
$51.52
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$79.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: IEHP medi-cal |
$352.13
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Innovage PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: Riverside University Health MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| 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 |
$12,338.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.97
|
| Rate for Payer: BCBS Transplant Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.75
|
| Rate for Payer: IEHP medi-cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: Riverside University Health MISP |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| 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 |
$588.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.85
|
| Rate for Payer: Vantage Medical Group Senior |
$17.85
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
IP
|
$966.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Central Health Plan Commercial |
$772.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$869.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$54,212.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.65
|
| Rate for Payer: BCBS Transplant Transplant |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$56.86
|
| Rate for Payer: Blue Shield of California EPN |
$44.71
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$69.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: IEHP medi-cal |
$1,772.71
|
| Rate for Payer: IEHP Medicare Advantage |
$1,074.37
|
| Rate for Payer: Innovage PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: Riverside University Health MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| 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 |
$54,212.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$1,569.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.07
|
| Rate for Payer: BCBS Transplant Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$44.50
|
| Rate for Payer: Blue Shield of California EPN |
$34.99
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.00
|
| Rate for Payer: IEHP medi-cal |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: Riverside University Health MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| 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 |
$1,569.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
IP
|
$301.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
IP
|
$320.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare 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 |
$229.58
|
| Rate for Payer: BCBS Transplant Transplant |
$69.60
|
| Rate for Payer: Blue Shield of California Commercial |
$71.69
|
| Rate for Payer: Blue Shield of California EPN |
$56.38
|
| Rate for Payer: Caremore Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: IEHP medi-cal |
$70.69
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Innovage PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| 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 |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: Riverside University Health MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| 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: 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
|
$108.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800210
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC CYTOPATH CONCENTRATION, PG
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800210
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.49
|
| Rate for Payer: BCBS Transplant Transplant |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$66.74
|
| Rate for Payer: Blue Shield of California EPN |
$52.49
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: IEHP medi-cal |
$82.68
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Innovage PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: Riverside University Health MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| 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 |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.49
|
| Rate for Payer: BCBS Transplant Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: IEHP medi-cal |
$82.68
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Innovage PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: Riverside University Health MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| 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 |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
IP
|
$507.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$456.30 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Central Health Plan Commercial |
$405.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$456.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.40
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC CYTOPATH, EXTENDED STUDY
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.52
|
| Rate for Payer: BCBS Transplant Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: IEHP medi-cal |
$111.70
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Innovage PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: Riverside University Health MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| 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 |
$4,111.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC CYTOPATH, EXTENDED STUDY
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC CYTOPATH-NGYN SMEAR
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$2,799.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.28
|
| Rate for Payer: BCBS Transplant Transplant |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$90.23
|
| Rate for Payer: Blue Shield of California EPN |
$70.96
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Central Health Plan Commercial |
$116.80
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$109.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: IEHP medi-cal |
$82.68
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Innovage PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: Riverside University Health MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| 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 |
$2,799.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC CYTOPATH-NGYN SMEAR
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Central Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: Galaxy Health WC |
$275.40
|
| Rate for Payer: Global Benefits Group Commercial |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: Networks By Design Commercial |
$210.60
|
| Rate for Payer: Prime Health Services Commercial |
$275.40
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$321.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.31
|
| Rate for Payer: BCBS Transplant Transplant |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$231.75
|
| Rate for Payer: Blue Shield of California EPN |
$182.25
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$281.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: IEHP medi-cal |
$111.70
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Innovage PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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 |
$4,111.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,289.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: BCBS Transplant Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.72
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Caremore Medicare Advantage |
$17.31
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.31
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.39
|
| Rate for Payer: IEHP medi-cal |
$28.56
|
| Rate for Payer: IEHP Medicare Advantage |
$17.31
|
| Rate for Payer: Innovage PACE Commercial |
$25.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$18.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: Riverside University Health MISP |
$19.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| 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 HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Vantage Medical Group Senior |
$17.31
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
