|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$591.15 |
| Max. Negotiated Rate |
$2,449.50 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,103.30
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,211.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,211.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.50
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$591.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,018.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,551.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,234.55
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,122.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,211.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,211.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,557.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,959.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.58 |
| Max. Negotiated Rate |
$3,719.25 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,193.60
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,357.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,357.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,239.75
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$896.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,064.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,874.50
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,223.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$896.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,357.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,357.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,365.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,031.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,239.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,975.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,975.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
OP
|
$4,375.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,703.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,078.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,653.75
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,843.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,086.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$791.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,625.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,625.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
IP
|
$4,375.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.88 |
| Max. Negotiated Rate |
$3,281.25 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,817.50
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$791.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
OP
|
$4,375.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,703.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,078.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,653.75
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,843.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,086.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$791.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,625.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,625.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
IP
|
$4,375.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.88 |
| Max. Negotiated Rate |
$3,281.25 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,817.50
|
| Rate for Payer: Cash Price |
$1,968.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$791.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
IP
|
$7,301.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,321.48 |
| Max. Negotiated Rate |
$5,475.75 |
| Rate for Payer: Adventist Health Commercial |
$1,460.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,701.84
|
| Rate for Payer: Cash Price |
$3,285.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,942.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,942.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,321.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.25
|
| Rate for Payer: Multiplan Commercial |
$5,475.75
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
OP
|
$7,301.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,321.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,460.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,512.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,467.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,759.78
|
| Rate for Payer: Cash Price |
$3,285.45
|
| Rate for Payer: Cash Price |
$3,285.45
|
| Rate for Payer: Cash Price |
$3,285.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,745.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,942.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,942.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,482.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,321.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$5,475.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.60
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
IP
|
$17,383.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,146.32 |
| Max. Negotiated Rate |
$13,037.25 |
| Rate for Payer: Adventist Health Commercial |
$3,476.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,194.65
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,768.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11,768.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,345.75
|
| Rate for Payer: Multiplan Commercial |
$13,037.25
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
OP
|
$17,383.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,146.32 |
| Max. Negotiated Rate |
$13,037.25 |
| Rate for Payer: Adventist Health Commercial |
$3,476.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,742.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,256.92
|
| Rate for Payer: Blue Shield of California EPN |
$6,570.77
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Cash Price |
$7,822.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,298.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,896.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,768.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11,768.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,291.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,146.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,930.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,345.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan Commercial |
$13,037.25
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,429.80
|
| Rate for Payer: TriValley Medical Group Senior |
$10,429.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$235.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.78
|
| Rate for Payer: Heritage Provider Network Senior |
$247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.76
|
| Rate for Payer: Blue Shield of California Commercial |
$81.65
|
| Rate for Payer: Blue Shield of California Commercial |
$81.65
|
| Rate for Payer: Blue Shield of California EPN |
$65.66
|
| Rate for Payer: Blue Shield of California EPN |
$65.66
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.55
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$226.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$174.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| 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: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.76
|
| Rate for Payer: Blue Shield of California Commercial |
$37.82
|
| Rate for Payer: Blue Shield of California Commercial |
$37.82
|
| Rate for Payer: Blue Shield of California EPN |
$30.42
|
| Rate for Payer: Blue Shield of California EPN |
$30.42
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.85
|
| 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: United Healthcare Navigate/Select/Select+ |
$7.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22.10
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.84
|
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$93.99
|
| Rate for Payer: Blue Shield of California EPN |
$93.99
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$613.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.34
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$584.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$450.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC CYTOLOGIC EXAM, IOC
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800181
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.94
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.09
|
| Rate for Payer: Heritage Provider Network Senior |
$639.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.31
|
| Rate for Payer: Blue Shield of California Commercial |
$71.57
|
| Rate for Payer: Blue Shield of California Commercial |
$71.57
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.95
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$43.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$140.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC CYTOLOGY IOC EA ADDL
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800182
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.34
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.75
|
| Rate for Payer: Heritage Provider Network Senior |
$164.65
|
| Rate for Payer: Heritage Provider Network Senior |
$193.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$126.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$149.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC CYTOMEG DNA QUANT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900912312
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.57
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
|
HC CYTOPATH CONCENTRATION, PG
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800210
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.62
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC CYTOPATH CONCENTRATION, PG
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800210
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$116.02 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.58
|
| Rate for Payer: Blue Shield of California Commercial |
$116.02
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.04
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| 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 |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$306.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.58
|
| Rate for Payer: Blue Shield of California Commercial |
$116.02
|
| Rate for Payer: Blue Shield of California Commercial |
$116.02
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.02
|
| Rate for Payer: Heritage Provider Network Senior |
$66.23
|
| Rate for Payer: Heritage Provider Network Senior |
$307.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$236.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.04
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| 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: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
