|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$18,298.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$16,468.20 |
| Rate for Payer: Adventist Health Commercial |
$3,659.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,553.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,063.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,723.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,859.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,746.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,063.90
|
| Rate for Payer: Cash Price |
$10,063.90
|
| Rate for Payer: Cash Price |
$10,063.90
|
| Rate for Payer: Central Health Plan Commercial |
$14,638.40
|
| Rate for Payer: Cigna of CA HMO |
$11,710.72
|
| Rate for Payer: Cigna of CA PPO |
$13,540.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,553.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,553.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,319.20
|
| Rate for Payer: Galaxy Health WC |
$15,553.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,468.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$9,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,326.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,659.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,808.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,808.60
|
| Rate for Payer: Multiplan Commercial |
$13,723.50
|
| Rate for Payer: Networks By Design Commercial |
$11,893.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,553.30
|
| Rate for Payer: Riverside University Health System MISP |
$7,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,978.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,978.80
|
| 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 |
$15,553.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,553.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15,553.30
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$18,298.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,659.60 |
| Max. Negotiated Rate |
$16,468.20 |
| Rate for Payer: Adventist Health Commercial |
$3,659.60
|
| Rate for Payer: Cash Price |
$10,063.90
|
| Rate for Payer: Central Health Plan Commercial |
$14,638.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,319.20
|
| Rate for Payer: Galaxy Health WC |
$15,553.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,971.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,326.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,659.60
|
| Rate for Payer: Multiplan Commercial |
$13,723.50
|
| Rate for Payer: Networks By Design Commercial |
$11,893.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,553.30
|
|
|
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 |
$9,288.90 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,256.80
|
| 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: Health Management Network EPO/PPO |
$9,288.90
|
| 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 |
$2,064.20
|
| Rate for Payer: Multiplan Commercial |
$7,740.75
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
|
|
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 |
$9,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$4,997.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,061.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,256.80
|
| 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: Health Management Network EPO/PPO |
$9,288.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$5,160.50
|
| 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 |
$2,064.20
|
| 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 |
$7,740.75
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,128.40
|
| 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
|
$11,869.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,373.80 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Adventist Health Commercial |
$2,373.80
|
| Rate for Payer: Cash Price |
$6,527.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,747.60
|
| Rate for Payer: Galaxy Health WC |
$10,088.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,682.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,916.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,522.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,346.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.80
|
| Rate for Payer: Multiplan Commercial |
$8,901.75
|
| Rate for Payer: Networks By Design Commercial |
$7,714.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,088.65
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$11,869.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Adventist Health Commercial |
$2,373.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,088.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,527.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,901.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,746.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,970.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,527.95
|
| Rate for Payer: Cash Price |
$6,527.95
|
| Rate for Payer: Cash Price |
$6,527.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,495.20
|
| Rate for Payer: Cigna of CA HMO |
$7,596.16
|
| Rate for Payer: Cigna of CA PPO |
$8,783.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,088.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,088.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,088.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,747.60
|
| Rate for Payer: Galaxy Health WC |
$10,088.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,682.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$5,934.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,916.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,346.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,308.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,308.30
|
| Rate for Payer: Multiplan Commercial |
$8,901.75
|
| Rate for Payer: Networks By Design Commercial |
$7,714.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,088.65
|
| Rate for Payer: Riverside University Health System MISP |
$4,747.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,121.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,088.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,088.65
|
| Rate for Payer: Vantage Medical Group Senior |
$10,088.65
|
|
|
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 |
$9,901.80 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Cash Price |
$6,051.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,801.60
|
| 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: Health Management Network EPO/PPO |
$9,901.80
|
| 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 |
$2,200.40
|
| Rate for Payer: Multiplan Commercial |
$8,251.50
|
| 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
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,901.80 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,681.51
|
| 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 Exchange |
$5,327.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,461.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,051.10
|
| Rate for Payer: Cash Price |
$6,051.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,801.60
|
| 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: Health Management Network EPO/PPO |
$9,901.80
|
| Rate for Payer: InnovAge PACE Commercial |
$5,501.00
|
| 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 |
$2,200.40
|
| 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 |
$8,251.50
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,400.80
|
| 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
|
OP
|
$9,352.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$8,416.80 |
| Rate for Payer: Adventist Health Commercial |
$1,870.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,679.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,949.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,143.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,014.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,528.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,492.43
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,143.60
|
| Rate for Payer: Cash Price |
$5,143.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,481.60
|
| Rate for Payer: Cigna of CA HMO |
$5,985.28
|
| Rate for Payer: Cigna of CA PPO |
$6,920.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,949.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,949.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,949.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,740.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,740.80
|
| Rate for Payer: Galaxy Health WC |
$7,949.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,611.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,416.80
|
| Rate for Payer: InnovAge PACE Commercial |
$4,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,237.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,788.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,870.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,546.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,546.40
|
| Rate for Payer: Multiplan Commercial |
$7,014.00
|
| Rate for Payer: Networks By Design Commercial |
$6,078.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,949.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,740.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,611.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,611.20
|
| 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 |
$7,949.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,949.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,949.20
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$9,352.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,870.40 |
| Max. Negotiated Rate |
$8,416.80 |
| Rate for Payer: Adventist Health Commercial |
$1,870.40
|
| Rate for Payer: Cash Price |
$5,143.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,740.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,740.80
|
| Rate for Payer: Galaxy Health WC |
$7,949.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,611.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,416.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,237.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,563.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,788.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,870.40
|
| Rate for Payer: Multiplan Commercial |
$7,014.00
|
| Rate for Payer: Networks By Design Commercial |
$6,078.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,949.20
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$5,983.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,196.60 |
| Max. Negotiated Rate |
$5,384.70 |
| Rate for Payer: Adventist Health Commercial |
$1,196.60
|
| Rate for Payer: Cash Price |
$3,290.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,786.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,393.20
|
| Rate for Payer: Galaxy Health WC |
$5,085.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,384.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,990.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,279.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,703.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.60
|
| Rate for Payer: Multiplan Commercial |
$4,487.25
|
| Rate for Payer: Networks By Design Commercial |
$3,888.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,085.55
|
|
|
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 |
$6,335.10 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,631.20
|
| 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: Health Management Network EPO/PPO |
$6,335.10
|
| 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 |
$1,407.80
|
| Rate for Payer: Multiplan Commercial |
$5,279.25
|
| 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 |
$274.01 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,274.78
|
| 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 Exchange |
$3,408.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,134.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,631.20
|
| 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: Health Management Network EPO/PPO |
$6,335.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| 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 |
$1,407.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$5,279.25
|
| Rate for Payer: Networks By Design Commercial |
$4,575.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,983.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| 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
|
$5,983.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$274.01 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,196.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,633.48
|
| 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 Exchange |
$2,896.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,513.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,290.65
|
| Rate for Payer: Cash Price |
$3,290.65
|
| Rate for Payer: Cash Price |
$3,290.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,786.40
|
| Rate for Payer: Cigna of CA HMO |
$3,829.12
|
| Rate for Payer: Cigna of CA PPO |
$4,427.42
|
| 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 |
$5,085.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,384.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,990.66
|
| 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 |
$1,196.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$4,487.25
|
| Rate for Payer: Networks By Design Commercial |
$3,888.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,085.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,589.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,589.80
|
| 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: 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
|
$55.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
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 |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| 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 Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| 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: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| 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 |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| 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
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22.40
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
|
|
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 |
$95.95 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.01
|
| 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 Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| 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: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: InnovAge PACE Commercial |
$19.68
|
| 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 |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.91
|
| Rate for Payer: Riverside University Health System MISP |
$14.43
|
| 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 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 |
$112.94 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| 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 Exchange |
$112.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.92
|
| Rate for Payer: Blue Shield of California Commercial |
$59.49
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| 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: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: InnovAge PACE Commercial |
$22.93
|
| 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 |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.29
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Medicare |
$16.21
|
| Rate for Payer: Riverside University Health System MISP |
$16.82
|
| 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
|
$98.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
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 |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| 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 Exchange |
$117.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.81
|
| Rate for Payer: Blue Shield of California Commercial |
$59.49
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| 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: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: InnovAge PACE Commercial |
$27.21
|
| 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 |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.14
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.23
|
| Rate for Payer: Riverside University Health System MISP |
$19.95
|
| 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
|
$98.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
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 |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| 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 Exchange |
$117.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.81
|
| Rate for Payer: Blue Shield of California Commercial |
$59.49
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| 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: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: InnovAge PACE Commercial |
$27.21
|
| 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 |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.14
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.23
|
| Rate for Payer: Riverside University Health System MISP |
$19.95
|
| 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
|
$840.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Adventist Health Commercial |
$168.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Senior |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$519.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
