|
HC CYTOPATH-CONCENTRATION TECH
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$319.42
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
|
|
HC CYTOPATH, EXTENDED STUDY
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| 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 |
$147.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.93
|
| 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 |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| 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 |
$155.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.94
|
| Rate for Payer: Heritage Provider Network Senior |
$66.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| 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: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC CYTOPATH, EXTENDED STUDY
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 88162
|
| Hospital Charge Code |
903800004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.92
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
|
HC CYTOPATH-NGYN SMEAR
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$237.75 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.91
|
| 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 |
$60.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.21
|
| Rate for Payer: Blue Shield of California Commercial |
$103.87
|
| Rate for Payer: Blue Shield of California Commercial |
$103.87
|
| Rate for Payer: Blue Shield of California EPN |
$83.53
|
| Rate for Payer: Blue Shield of California EPN |
$83.53
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$206.05
|
| 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 |
$206.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.95
|
| 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 |
$88.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$196.22
|
| Rate for Payer: Heritage Provider Network Senior |
$88.52
|
| Rate for Payer: Heritage Provider Network Senior |
$196.22
|
| 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 |
$68.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$151.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.38
|
| 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 |
$79.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| 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 |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
| 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
|
|
|
HC CYTOPATH-NGYN SMEAR
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
903800005
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$237.75 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.15
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.61
|
| Rate for Payer: Heritage Provider Network Senior |
$214.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$419.78 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.78
|
| Rate for Payer: Blue Shield of California Commercial |
$299.81
|
| Rate for Payer: Blue Shield of California EPN |
$241.10
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$307.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| 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 |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC CYTOPATH NONGYN THIN PREP
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
903800244
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.61
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC CYTOPATH, PAP SMEAR W/O REVIEW
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$85.02 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$85.02
|
| Rate for Payer: Blue Shield of California Commercial |
$85.02
|
| Rate for Payer: Blue Shield of California EPN |
$68.19
|
| Rate for Payer: Blue Shield of California EPN |
$68.19
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.54
|
| Rate for Payer: TriValley Medical Group Senior |
$18.54
|
| Rate for Payer: TriValley Medical Group Senior |
$18.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| 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 |
$245.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.22
|
| Rate for Payer: Blue Shield of California Commercial |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$136.22
|
| Rate for Payer: Blue Shield of California EPN |
$109.55
|
| Rate for Payer: Blue Shield of California EPN |
$109.55
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| 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 |
$258.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.74
|
| Rate for Payer: Heritage Provider Network Senior |
$66.23
|
| Rate for Payer: Heritage Provider Network Senior |
$245.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$189.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$255.67
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.77
|
| Rate for Payer: Heritage Provider Network Senior |
$268.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$85.02 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.88
|
| Rate for Payer: Blue Shield of California Commercial |
$85.02
|
| Rate for Payer: Blue Shield of California Commercial |
$85.02
|
| Rate for Payer: Blue Shield of California EPN |
$68.19
|
| Rate for Payer: Blue Shield of California EPN |
$68.19
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.54
|
| Rate for Payer: TriValley Medical Group Senior |
$18.54
|
| Rate for Payer: TriValley Medical Group Senior |
$18.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.82
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.22
|
| Rate for Payer: Blue Shield of California Commercial |
$136.22
|
| Rate for Payer: Blue Shield of California EPN |
$109.55
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.95
|
| Rate for Payer: Heritage Provider Network Senior |
$43.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| 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 Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| 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 SMEARS ANY SOURCE PG
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$53.25 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.72
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.07
|
| Rate for Payer: Heritage Provider Network Senior |
$48.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.10
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.87
|
| Rate for Payer: Heritage Provider Network Senior |
$56.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$116.02 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.91
|
| 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 |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| 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 |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| 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 THINPREP PAP
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.19
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.74
|
| Rate for Payer: Heritage Provider Network Senior |
$113.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.24
|
| Rate for Payer: Blue Shield of California Commercial |
$163.07
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.26
|
| Rate for Payer: TriValley Medical Group Senior |
$20.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.80
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.02
|
| Rate for Payer: Blue Shield of California Commercial |
$163.07
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Senior |
$87.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$67.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Senior |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Vantage Medical Group Senior |
$23.04
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| 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 DACRYOCYSTOGRAM
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.77 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.94
|
| Rate for Payer: Blue Shield of California Commercial |
$200.54
|
| Rate for Payer: Blue Shield of California EPN |
$161.27
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$541.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.63
|
| Rate for Payer: Heritage Provider Network Senior |
$515.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$397.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| 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 |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.55
|
| Rate for Payer: Heritage Provider Network Senior |
$226.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$174.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$256.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.10
|
| Rate for Payer: Vantage Medical Group Senior |
$311.10
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.77 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$536.45
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$563.94
|
| Rate for Payer: Heritage Provider Network Senior |
$563.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
|
