|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$8,975.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,795.00 |
| Max. Negotiated Rate |
$8,077.50 |
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,590.00
|
| Rate for Payer: Galaxy Health WC |
$7,628.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,385.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,077.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,986.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,419.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,795.00
|
| Rate for Payer: Multiplan Commercial |
$6,731.25
|
| Rate for Payer: Networks By Design Commercial |
$5,833.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,628.75
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$8,975.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,795.00 |
| Max. Negotiated Rate |
$8,077.50 |
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,590.00
|
| Rate for Payer: Galaxy Health WC |
$7,628.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,385.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,077.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,986.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,419.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,795.00
|
| Rate for Payer: Multiplan Commercial |
$6,731.25
|
| Rate for Payer: Networks By Design Commercial |
$5,833.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,628.75
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,581.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,316.20 |
| Max. Negotiated Rate |
$10,422.90 |
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,632.40
|
| Rate for Payer: Galaxy Health WC |
$9,843.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,948.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,422.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,724.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,412.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.20
|
| Rate for Payer: Multiplan Commercial |
$8,685.75
|
| Rate for Payer: Networks By Design Commercial |
$7,527.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,843.85
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,581.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,316.20 |
| Max. Negotiated Rate |
$10,422.90 |
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,632.40
|
| Rate for Payer: Galaxy Health WC |
$9,843.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,948.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,422.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,724.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,412.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.20
|
| Rate for Payer: Multiplan Commercial |
$8,685.75
|
| Rate for Payer: Networks By Design Commercial |
$7,527.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,843.85
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,581.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$10,422.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$328.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,843.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,369.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,369.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,948.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,264.80
|
| Rate for Payer: Cigna of CA HMO |
$7,411.84
|
| Rate for Payer: Cigna of CA PPO |
$8,569.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,843.85
|
| Rate for Payer: Dignity Health Media |
$9,843.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,843.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,632.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,632.40
|
| Rate for Payer: Galaxy Health WC |
$9,843.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,948.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,422.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,685.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,053.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,724.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.20
|
| Rate for Payer: Multiplan Commercial |
$8,685.75
|
| Rate for Payer: Networks By Design Commercial |
$7,527.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,843.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,948.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,948.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,843.85
|
| Rate for Payer: Vantage Medical Group Senior |
$9,843.85
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,581.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$10,422.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$328.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,843.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,369.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,369.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,948.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,264.80
|
| Rate for Payer: Cigna of CA HMO |
$7,411.84
|
| Rate for Payer: Cigna of CA PPO |
$8,569.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,843.85
|
| Rate for Payer: Dignity Health Media |
$9,843.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,843.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,632.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,632.40
|
| Rate for Payer: Galaxy Health WC |
$9,843.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,948.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,422.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,685.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,053.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,724.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.20
|
| Rate for Payer: Multiplan Commercial |
$8,685.75
|
| Rate for Payer: Networks By Design Commercial |
$7,527.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,843.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,948.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,948.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,843.85
|
| Rate for Payer: Vantage Medical Group Senior |
$9,843.85
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,409.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,481.80 |
| Max. Negotiated Rate |
$6,668.10 |
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,927.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.60
|
| Rate for Payer: Galaxy Health WC |
$6,297.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,445.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,668.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.80
|
| Rate for Payer: Multiplan Commercial |
$5,556.75
|
| Rate for Payer: Networks By Design Commercial |
$4,815.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,297.65
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,409.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$302.69 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,486.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,445.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,486.99
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,927.20
|
| Rate for Payer: Cigna of CA HMO |
$4,741.76
|
| Rate for Payer: Cigna of CA PPO |
$5,482.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$6,297.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,445.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,668.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,556.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,453.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2,230.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,992.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$5,556.75
|
| Rate for Payer: Networks By Design Commercial |
$4,815.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,297.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,576.21
|
| Rate for Payer: Riverside University Health System MISP |
$1,635.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,445.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,445.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,409.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,481.80 |
| Max. Negotiated Rate |
$6,668.10 |
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,927.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.60
|
| Rate for Payer: Galaxy Health WC |
$6,297.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,445.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,668.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.80
|
| Rate for Payer: Multiplan Commercial |
$5,556.75
|
| Rate for Payer: Networks By Design Commercial |
$4,815.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,297.65
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,409.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$302.69 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,486.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,445.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,486.99
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,927.20
|
| Rate for Payer: Cigna of CA HMO |
$4,741.76
|
| Rate for Payer: Cigna of CA PPO |
$5,482.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$6,297.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,445.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,668.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,556.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,453.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2,230.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,992.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$5,556.75
|
| Rate for Payer: Networks By Design Commercial |
$4,815.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,297.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,576.21
|
| Rate for Payer: Riverside University Health System MISP |
$1,635.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,445.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,445.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| 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 |
$45.88
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.55
|
| 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 |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: 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
|
$39.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.27
|
| 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 |
$117.03
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Media |
$13.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| 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 |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: 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
|
$58.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC EPSTEIN BARR NUCLEAR ANTIGEN IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$137.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.94
|
| 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 |
$137.76
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.94
|
| Rate for Payer: Dignity Health Media |
$15.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.29
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: InnovAge PACE Commercial |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$22.94
|
| 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
|
$58.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.14
|
| 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 |
$143.08
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Media |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.93
|
| 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 |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: 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
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.14
|
| 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 |
$143.08
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Media |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.93
|
| 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 |
$26.01
|
| 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 |
$7.80
|
| 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 |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| 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 |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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: 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
|
$58.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820014
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$307.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.16
|
| Rate for Payer: Blue Distinction Transplant |
$381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Central Health Plan Commercial |
$508.00
|
| Rate for Payer: Cigna of CA HMO |
$406.40
|
| Rate for Payer: Cigna of CA PPO |
$469.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$571.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$476.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820014
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Central Health Plan Commercial |
$508.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$571.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.00
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Central Health Plan Commercial |
$508.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$571.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.00
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$307.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.16
|
| Rate for Payer: Blue Distinction Transplant |
$381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Central Health Plan Commercial |
$508.00
|
| Rate for Payer: Cigna of CA HMO |
$406.40
|
| Rate for Payer: Cigna of CA PPO |
$469.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$571.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$476.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EP ST J ABLATION CABLE
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
906812640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| 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: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
