|
HC EA ADDL ULTRASOUND
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$113.56
|
| Rate for Payer: Blue Shield of California Commercial |
$74.94
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$702.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.00
|
| Rate for Payer: United Healthcare All Other HMO |
$89.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC EBER
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$780.38 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$780.38
|
| 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 Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.86
|
| Rate for Payer: Blue Shield of California Commercial |
$126.16
|
| Rate for Payer: Blue Shield of California Commercial |
$83.44
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| 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 Senior |
$219.12
|
|
|
HC EBER
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$703.02 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$480.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$703.02
|
| Rate for Payer: Blue Shield of California Commercial |
$296.92
|
| Rate for Payer: Blue Shield of California Commercial |
$196.39
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna of CA HMO |
$272.64
|
| Rate for Payer: Cigna of CA PPO |
$315.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$270.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.20
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.77
|
| Rate for Payer: United Healthcare All Other HMO |
$85.77
|
| Rate for Payer: United Healthcare HMO Rider |
$85.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.10
|
| Rate for Payer: Vantage Medical Group Senior |
$362.10
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$362.10 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$270.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.24
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
|
|
HC EBNA IGG
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.24
|
| Rate for Payer: Blue Shield of California Commercial |
$32.27
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.23
|
| Rate for Payer: EPIC Health Plan Senior |
$16.82
|
| Rate for Payer: EPIC Health Plan Senior |
$16.82
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
|
|
HC EBNA IGG
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$333.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Cigna of CA HMO |
$1,068.16
|
| Rate for Payer: Cigna of CA PPO |
$1,235.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$1,418.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,001.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,036.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,059.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,172.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,084.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,418.65
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$333.80 |
| Max. Negotiated Rate |
$1,418.65 |
| Rate for Payer: Adventist Health Commercial |
$333.80
|
| Rate for Payer: Cash Price |
$751.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$667.60
|
| Rate for Payer: Galaxy Health WC |
$1,418.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,001.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,059.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$984.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.56
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: Networks By Design Commercial |
$1,084.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,418.65
|
|
|
HC EBV DNA PCR TEST
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC EBV DNA PCR TEST
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| 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 |
$267.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$100.37
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$66.38
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| 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/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| 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 EBV IGG EARLY AB
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$14.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.43
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
|
HC EBV IGG EARLY AB
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
|
HC EBV PCR
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| 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 |
$267.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$273.37
|
| Rate for Payer: Blue Shield of California Commercial |
$127.70
|
| Rate for Payer: Blue Shield of California Commercial |
$413.32
|
| Rate for Payer: Blue Shield of California Commercial |
$193.07
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$379.52
|
| Rate for Payer: Cigna of CA HMO |
$177.28
|
| Rate for Payer: Cigna of CA PPO |
$204.98
|
| Rate for Payer: Cigna of CA PPO |
$438.82
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Galaxy Health WC |
$504.05
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| 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/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$376.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$385.45
|
| Rate for Payer: Networks By Design Commercial |
$180.05
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Prime Health Services Commercial |
$504.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| 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 EBV PCR
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.60 |
| Max. Negotiated Rate |
$504.05 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.20
|
| Rate for Payer: EPIC Health Plan Senior |
$237.20
|
| Rate for Payer: Galaxy Health WC |
$504.05
|
| Rate for Payer: Global Benefits Group Commercial |
$355.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$376.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.32
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: Networks By Design Commercial |
$385.45
|
| Rate for Payer: Prime Health Services Commercial |
$504.05
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.43
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$52.97
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$19.95
|
| Rate for Payer: EPIC Health Plan Senior |
$19.95
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC ECG 48 HR MONITOR-RECORDING
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$257.80 |
| Max. Negotiated Rate |
$1,095.65 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$902.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$515.60
|
| Rate for Payer: Galaxy Health WC |
$1,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$773.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$818.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$760.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.36
|
| Rate for Payer: Multiplan Commercial |
$1,031.20
|
| Rate for Payer: Networks By Design Commercial |
$837.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,095.65
|
|
|
HC ECG 48 HR MONITOR-RECORDING
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.15
|
| Rate for Payer: Blue Shield of California Commercial |
$542.67
|
| Rate for Payer: Blue Shield of California Commercial |
$822.38
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cigna of CA HMO |
$824.96
|
| Rate for Payer: Cigna of CA PPO |
$953.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$902.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$773.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$818.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,031.20
|
| Rate for Payer: Networks By Design Commercial |
$837.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,095.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$773.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$773.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,006.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC ECG TRACING ONLY
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
941093005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
905493005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECG TRACING ONLY
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECG TRACING ONLY
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
941093005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECG TRACING ONLY
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
905493005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
