|
HC FINE NDL ASP WO IMG EA ADD LSN
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 10004
|
| Hospital Charge Code |
903810004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$524.70 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.60
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.41 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,559.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$1,169.55
|
| Rate for Payer: Cash Price |
$1,169.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,079.20
|
| Rate for Payer: Cigna of CA PPO |
$1,923.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,209.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,559.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,339.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,949.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,733.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,949.25
|
| Rate for Payer: Networks By Design Commercial |
$1,689.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,209.15
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,559.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FINE NDLE ASPIR W/GUIDANCE
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
CPT 62267
|
| Hospital Charge Code |
909000240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.80 |
| Max. Negotiated Rate |
$2,339.10 |
| Rate for Payer: Cash Price |
$1,169.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,079.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.60
|
| Rate for Payer: Galaxy Health WC |
$2,209.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,559.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,339.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,733.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$990.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$1,949.25
|
| Rate for Payer: Networks By Design Commercial |
$1,689.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,209.15
|
|
|
HC FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$388.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.02
|
| Rate for Payer: Blue Distinction Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$207.65
|
| Rate for Payer: Blue Shield of California EPN |
$163.30
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| 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 |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: InnovAge PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| 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 |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Riverside University Health System MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: 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 FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$154.40 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Central Health Plan Commercial |
$617.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.80
|
| Rate for Payer: Galaxy Health WC |
$656.20
|
| Rate for Payer: Global Benefits Group Commercial |
$463.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$694.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$579.00
|
| Rate for Payer: Networks By Design Commercial |
$501.80
|
| Rate for Payer: Prime Health Services Commercial |
$656.20
|
|
|
HC FINE NEEDLE ASPIRATION PG
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$388.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.02
|
| Rate for Payer: Blue Distinction Transplant |
$74.40
|
| Rate for Payer: Blue Shield of California Commercial |
$76.63
|
| Rate for Payer: Blue Shield of California EPN |
$60.26
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| 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 |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: InnovAge PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| 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 |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Riverside University Health System MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: 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 FINE NEEDLE ASPIRATION PG
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$144.60
|
| Rate for Payer: Blue Shield of California Commercial |
$148.94
|
| Rate for Payer: Blue Shield of California EPN |
$117.13
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Central Health Plan Commercial |
$192.80
|
| Rate for Payer: Cigna of CA HMO |
$154.24
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$180.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.50
|
| Rate for Payer: United Healthcare All Other HMO |
$120.50
|
| Rate for Payer: United Healthcare HMO Rider |
$120.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$1,132.20 |
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.20
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,132.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.60
|
| Rate for Payer: Multiplan Commercial |
$943.50
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$144.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Central Health Plan Commercial |
$192.80
|
| Rate for Payer: Cigna of CA PPO |
$178.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$180.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$1,132.20 |
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.20
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,132.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.60
|
| Rate for Payer: Multiplan Commercial |
$943.50
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
|
|
HC FINGERS MIN 2 VIEWS
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
909001521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.11
|
| Rate for Payer: Blue Distinction Transplant |
$397.80
|
| Rate for Payer: Blue Shield of California Commercial |
$409.73
|
| Rate for Payer: Blue Shield of California EPN |
$322.22
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$424.32
|
| Rate for Payer: Cigna of CA PPO |
$490.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$497.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC FINGERS MIN 2 VIEWS
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
909001521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Cash Price |
$298.35
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
|
|
HC FISH INTERPHASE 100-300 CELLS
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900918011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$2,322.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,322.69
|
| Rate for Payer: Blue Distinction Transplant |
$138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$142.14
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| Rate for Payer: Caremore Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Media |
$51.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$172.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: InnovAge PACE Commercial |
$76.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC FISH INTERPHASE 100-300 CELLS
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900918011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC FISH INTERPHASE 25-99 CELLS
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900918010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$1,858.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,523.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,858.15
|
| Rate for Payer: Blue Distinction Transplant |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.03
|
| Rate for Payer: Blue Shield of California EPN |
$76.30
|
| Rate for Payer: Caremore Medicare Advantage |
$42.38
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Media |
$42.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.38
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: InnovAge PACE Commercial |
$63.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.79
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Riverside University Health System MISP |
$46.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.33
|
| Rate for Payer: United Healthcare All Other HMO |
$34.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC FISH INTERPHASE 25-99 CELLS
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900918010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,686.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$34.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,382.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,686.10
|
| Rate for Payer: Blue Distinction 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 |
$34.81
|
| 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 |
$52.22
|
| Rate for Payer: Dignity Health Media |
$34.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.81
|
| 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) Other |
$109.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: InnovAge PACE Commercial |
$52.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| 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 |
$36.90
|
| Rate for Payer: Riverside University Health System MISP |
$38.29
|
| 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 |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Central Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.40
|
| Rate for Payer: Galaxy Health WC |
$175.10
|
| Rate for Payer: Global Benefits Group Commercial |
$123.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.20
|
| Rate for Payer: Multiplan Commercial |
$154.50
|
| Rate for Payer: Networks By Design Commercial |
$133.90
|
| Rate for Payer: Prime Health Services Commercial |
$175.10
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$1,582.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$40.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,297.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,582.87
|
| Rate for Payer: Blue Distinction Transplant |
$80.40
|
| Rate for Payer: Blue Shield of California Commercial |
$82.81
|
| Rate for Payer: Blue Shield of California EPN |
$65.12
|
| Rate for Payer: Caremore Medicare Advantage |
$40.70
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.05
|
| Rate for Payer: Dignity Health Media |
$40.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.70
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$100.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$66.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.70
|
| Rate for Payer: InnovAge PACE Commercial |
$61.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Prime Health Services Medicare |
$43.14
|
| Rate for Payer: Riverside University Health System MISP |
$44.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.97
|
| Rate for Payer: United Healthcare All Other HMO |
$32.97
|
| Rate for Payer: United Healthcare HMO Rider |
$32.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Vantage Medical Group Senior |
$40.70
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,505.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,505.45
|
| Rate for Payer: Blue Distinction Transplant |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.03
|
| Rate for Payer: Blue Shield of California EPN |
$76.30
|
| Rate for Payer: Caremore Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Media |
$21.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$216.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Central Health Plan Commercial |
$288.80
|
| Rate for Payer: Cigna of CA PPO |
$267.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.85
|
| Rate for Payer: Dignity Health Media |
$306.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.40
|
| Rate for Payer: Galaxy Health WC |
$306.85
|
| Rate for Payer: Global Benefits Group Commercial |
$216.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.20
|
| Rate for Payer: Multiplan Commercial |
$270.75
|
| Rate for Payer: Networks By Design Commercial |
$234.65
|
| Rate for Payer: Prime Health Services Commercial |
$306.85
|
| Rate for Payer: Riverside University Health System MISP |
$144.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.85
|
| Rate for Payer: Vantage Medical Group Senior |
$306.85
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.20 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Central Health Plan Commercial |
$288.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.40
|
| Rate for Payer: Galaxy Health WC |
$306.85
|
| Rate for Payer: Global Benefits Group Commercial |
$216.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.20
|
| Rate for Payer: Multiplan Commercial |
$270.75
|
| Rate for Payer: Networks By Design Commercial |
$234.65
|
| Rate for Payer: Prime Health Services Commercial |
$306.85
|
|
