|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
IP
|
$4,004.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$724.72 |
| Max. Negotiated Rate |
$3,003.00 |
| Rate for Payer: Adventist Health Commercial |
$800.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,750.75
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,710.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,710.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$3,003.00
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
OP
|
$4,004.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$724.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$800.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,750.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,602.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,710.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,710.71
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,929.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,003.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,453.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,337.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
IP
|
$4,004.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$724.72 |
| Max. Negotiated Rate |
$3,003.00 |
| Rate for Payer: Adventist Health Commercial |
$800.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,750.75
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,710.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,710.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$3,003.00
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
IP
|
$6,683.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,209.62 |
| Max. Negotiated Rate |
$5,012.25 |
| Rate for Payer: Adventist Health Commercial |
$1,336.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,591.22
|
| Rate for Payer: Cash Price |
$3,007.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,524.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,524.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.75
|
| Rate for Payer: Multiplan Commercial |
$5,012.25
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
OP
|
$6,683.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,591.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$3,007.35
|
| Rate for Payer: Cash Price |
$3,007.35
|
| Rate for Payer: Cash Price |
$3,007.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,343.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,524.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,524.39
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,221.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$5,012.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,426.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,232.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
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 |
$2,671.56 |
| Max. Negotiated Rate |
$11,070.00 |
| Rate for Payer: Adventist Health Commercial |
$2,952.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,140.12
|
| Rate for Payer: Cash Price |
$6,642.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,992.52
|
| Rate for Payer: Heritage Provider Network Senior |
$9,992.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,671.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,690.00
|
| Rate for Payer: Multiplan Commercial |
$11,070.00
|
|
|
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 |
$936.00 |
| Max. Negotiated Rate |
$11,070.00 |
| Rate for Payer: Adventist Health Commercial |
$2,952.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,140.12
|
| 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 HMO/PPO |
$4,547.00
|
| 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: Cigna of CA HMO/PPO |
$9,594.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: Dignity Health Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,992.52
|
| Rate for Payer: Heritage Provider Network Senior |
$9,992.52
|
| Rate for Payer: Humana Medicare |
$6,465.01
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,114.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,671.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,628.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,690.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,145.91
|
| Rate for Payer: Multiplan Commercial |
$11,070.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,359.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,931.32
|
| 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 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 |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
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 |
$19.19 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| 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 HMO/PPO |
$87.06
|
| Rate for Payer: Blue Shield of California Commercial |
$65.83
|
| Rate for Payer: Blue Shield of California EPN |
$62.22
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$44.13
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| 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,EA ADDL SAME SIT
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| 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 |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.70
|
| Rate for Payer: Blue Shield of California Commercial |
$13.04
|
| Rate for Payer: Blue Shield of California EPN |
$12.33
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.85
|
| Rate for Payer: Dignity Health Senior |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: IEHP Medi-Cal |
$33.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.85
|
| 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 |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| 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 HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$75.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.80
|
| Rate for Payer: Heritage Provider Network Senior |
$71.80
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$59.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| 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 CYTOMEG DNA QUANT
|
Facility
IP
|
$320.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
IP
|
$507.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.31
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.24
|
| Rate for Payer: Heritage Provider Network Senior |
$343.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.75
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
|
|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| 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 HMO/PPO |
$55.17
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California EPN |
$64.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: IEHP Medi-Cal |
$45.12
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.11
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| 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 NONGYN THIN PREP
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$370.06 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| 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 HMO/PPO |
$370.06
|
| Rate for Payer: Blue Shield of California Commercial |
$232.88
|
| Rate for Payer: Blue Shield of California EPN |
$220.12
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: Dignity Health Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Humana Medicare |
$67.70
|
| Rate for Payer: IEHP Medi-Cal |
$95.04
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.30
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.70
|
| Rate for Payer: TriValley Medical Group Senior |
$67.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| 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 |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.39
|
| Rate for Payer: Blue Shield of California Commercial |
$68.31
|
| Rate for Payer: Blue Shield of California EPN |
$64.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: IEHP Medi-Cal |
$32.23
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.92
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.86
|
| Rate for Payer: Heritage Provider Network Senior |
$274.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
OP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$256.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$317.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$280.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.90
|
| Rate for Payer: Dignity Health Senior |
$317.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.51
|
| Rate for Payer: Heritage Provider Network Senior |
$231.51
|
| Rate for Payer: IEHP Medi-Cal |
$379.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.50
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.90
|
| Rate for Payer: Vantage Medical Group Senior |
$317.90
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
IP
|
$762.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$523.49
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.87
|
| Rate for Payer: Heritage Provider Network Senior |
$515.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
IP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$256.94
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.20
|
| Rate for Payer: Heritage Provider Network Senior |
$253.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.50
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
OP
|
$762.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$581.70 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$512.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$523.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.63
|
| Rate for Payer: Blue Shield of California Commercial |
$194.69
|
| Rate for Payer: Blue Shield of California EPN |
$110.72
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.68
|
| Rate for Payer: Heritage Provider Network Senior |
$471.68
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$67.52
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$768.89 |
| Max. Negotiated Rate |
$3,186.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,638.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,493.58
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,629.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,629.51
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: IEHP Medi-Cal |
$618.01
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,421.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,124.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,124.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
