|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$10,321.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,676.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,740.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Cigna of CA HMO |
$6,605.44
|
| Rate for Payer: Cigna of CA PPO |
$7,637.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,772.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,772.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,128.40
|
| Rate for Payer: Galaxy Health WC |
$8,772.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,192.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,884.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,388.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,224.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,224.70
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,772.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,772.85
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$8,773.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,754.60 |
| Max. Negotiated Rate |
$7,457.05 |
| Rate for Payer: Adventist Health Commercial |
$1,754.60
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,509.20
|
| Rate for Payer: Galaxy Health WC |
$7,457.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,263.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,342.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,430.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,105.52
|
| Rate for Payer: Multiplan Commercial |
$7,018.40
|
| Rate for Payer: Networks By Design Commercial |
$5,702.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,457.05
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$8,773.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,754.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,825.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,579.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Cigna of CA HMO |
$5,614.72
|
| Rate for Payer: Cigna of CA PPO |
$6,492.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,457.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,457.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,509.20
|
| Rate for Payer: Galaxy Health WC |
$7,457.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,263.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,430.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,105.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,141.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,141.10
|
| Rate for Payer: Multiplan Commercial |
$7,018.40
|
| Rate for Payer: Networks By Design Commercial |
$5,702.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,457.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,263.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,263.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,457.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,457.05
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$10,321.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,064.20 |
| Max. Negotiated Rate |
$8,772.85 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,128.40
|
| Rate for Payer: Galaxy Health WC |
$8,772.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,884.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,932.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,388.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.04
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,351.70 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,216.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,051.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,251.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: Cigna of CA HMO |
$7,041.28
|
| Rate for Payer: Cigna of CA PPO |
$8,141.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,351.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,351.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,701.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,701.40
|
| Rate for Payer: Multiplan Commercial |
$8,801.60
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,351.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,351.70
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,320.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,264.00 |
| Max. Negotiated Rate |
$9,622.00 |
| Rate for Payer: Adventist Health Commercial |
$2,264.00
|
| Rate for Payer: Cash Price |
$5,094.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,528.00
|
| Rate for Payer: Galaxy Health WC |
$9,622.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,312.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,007.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,716.80
|
| Rate for Payer: Multiplan Commercial |
$9,056.00
|
| Rate for Payer: Networks By Design Commercial |
$7,358.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,622.00
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,200.40 |
| Max. Negotiated Rate |
$9,351.70 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.48
|
| Rate for Payer: Multiplan Commercial |
$8,801.60
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,320.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,622.00 |
| Rate for Payer: Adventist Health Commercial |
$2,264.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,424.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,622.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,226.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,490.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,094.00
|
| Rate for Payer: Cash Price |
$5,094.00
|
| Rate for Payer: Cigna of CA HMO |
$7,244.80
|
| Rate for Payer: Cigna of CA PPO |
$8,376.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,622.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,622.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,622.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,528.00
|
| Rate for Payer: Galaxy Health WC |
$9,622.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,007.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,716.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,924.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,924.00
|
| Rate for Payer: Multiplan Commercial |
$9,056.00
|
| Rate for Payer: Networks By Design Commercial |
$7,358.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,622.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,622.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,622.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,622.00
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,242.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,448.40 |
| Max. Negotiated Rate |
$6,155.70 |
| Rate for Payer: Adventist Health Commercial |
$1,448.40
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,896.80
|
| Rate for Payer: Galaxy Health WC |
$6,155.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,345.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,830.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,759.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.08
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: Networks By Design Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,155.70
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,039.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,407.80 |
| Max. Negotiated Rate |
$5,983.15 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Cash Price |
$3,167.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,815.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,815.60
|
| Rate for Payer: Galaxy Health WC |
$5,983.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,223.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,681.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,357.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.36
|
| Rate for Payer: Multiplan Commercial |
$5,631.20
|
| Rate for Payer: Networks By Design Commercial |
$4,575.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,983.15
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,039.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$267.64 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,616.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,167.55
|
| Rate for Payer: Cash Price |
$3,167.55
|
| Rate for Payer: Cash Price |
$3,167.55
|
| Rate for Payer: Cigna of CA HMO |
$4,504.96
|
| Rate for Payer: Cigna of CA PPO |
$5,208.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$5,983.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,223.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$5,631.20
|
| Rate for Payer: Networks By Design Commercial |
$4,575.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,983.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,223.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,223.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,242.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$267.64 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,448.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,750.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: Cigna of CA HMO |
$4,634.88
|
| Rate for Payer: Cigna of CA PPO |
$5,359.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$6,155.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,345.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,830.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: Networks By Design Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,155.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,345.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,345.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC EPSTEIN BARR EARLY ANTIGEN IGG
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.73
|
| 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 Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$37.46
|
| Rate for Payer: Blue Shield of California EPN |
$24.75
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.52
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| 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 HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| 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 Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
|
HC EPSTEIN BARR EARLY ANTIGEN IGG
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC EPSTEIN BARR NUCLEAR ANTIGEN IGG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$153.34 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| 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 Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.34
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.29
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.08
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| 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 Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC EPSTEIN BARR NUCLEAR ANTIGEN IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$159.26 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| 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 Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.26
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.75
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| 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 Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGM
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$159.26 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| 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 Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.26
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.75
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| 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 Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EP ST J ABLATION CABLE
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
906812640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
