|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,740.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,400.94 |
| Max. Negotiated Rate |
$5,805.00 |
| Rate for Payer: Adventist Health Commercial |
$1,548.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,317.38
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,935.00
|
| Rate for Payer: Multiplan Commercial |
$5,805.00
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,740.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.49 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,548.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,317.38
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,031.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,791.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,829.00
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$5,805.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,200.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,200.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| 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 ANTIBODY SCREEN IGM
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
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 |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
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 |
$7.06 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$102.46
|
| Rate for Payer: Blue Shield of California EPN |
$80.10
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Senior |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$13.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.12
|
| Rate for Payer: TriValley Medical Group Senior |
$13.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.17
|
| 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
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
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 |
$7.06 |
| Max. Negotiated Rate |
$129.95 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| 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 HMO/PPO |
$129.95
|
| Rate for Payer: Blue Shield of California Commercial |
$119.51
|
| Rate for Payer: Blue Shield of California EPN |
$93.43
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Senior |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.27
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Senior |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.51
|
| 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 VIRAL CAPSID IGG
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
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 |
$7.06 |
| Max. Negotiated Rate |
$136.12 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.96
|
| Rate for Payer: Blue Shield of California Commercial |
$136.12
|
| Rate for Payer: Blue Shield of California EPN |
$106.41
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Senior |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$18.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.60
|
| 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 |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
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 |
$7.06 |
| Max. Negotiated Rate |
$136.12 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.96
|
| Rate for Payer: Blue Shield of California Commercial |
$136.12
|
| Rate for Payer: Blue Shield of California EPN |
$106.41
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Senior |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$18.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.60
|
| 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
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820014
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820014
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| 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: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.06
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| 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: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.06
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$7,720.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$458.58 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,544.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,303.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,562.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,246.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,790.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,018.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,562.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,562.00
|
| Rate for Payer: Dignity Health Senior |
$6,562.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,018.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,778.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4,778.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$458.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,721.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,397.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,930.00
|
| Rate for Payer: Multiplan Commercial |
$5,790.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,562.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,562.00
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$6,452.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,167.81 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,290.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,432.52
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.00
|
| Rate for Payer: Multiplan Commercial |
$4,839.00
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$6,452.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$458.58 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,290.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,432.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,484.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,548.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,839.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,193.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,484.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,484.20
|
| Rate for Payer: Dignity Health Senior |
$5,484.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,193.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,993.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,993.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$458.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,109.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.00
|
| Rate for Payer: Multiplan Commercial |
$4,839.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,484.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,484.20
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$7,720.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,397.32 |
| Max. Negotiated Rate |
$5,790.00 |
| Rate for Payer: Adventist Health Commercial |
$1,544.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,303.64
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,397.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,930.00
|
| Rate for Payer: Multiplan Commercial |
$5,790.00
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$6,452.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,167.81 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,290.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,432.52
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.00
|
| Rate for Payer: Multiplan Commercial |
$4,839.00
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$7,412.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,341.57 |
| Max. Negotiated Rate |
$5,559.00 |
| Rate for Payer: Adventist Health Commercial |
$1,482.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,092.04
|
| Rate for Payer: Cash Price |
$3,335.40
|
| Rate for Payer: Cash Price |
$3,335.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.00
|
| Rate for Payer: Multiplan Commercial |
$5,559.00
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$7,412.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$158.25 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,482.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,092.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,331.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,335.40
|
| Rate for Payer: Cash Price |
$3,335.40
|
| Rate for Payer: Cash Price |
$3,335.40
|
| Rate for Payer: Cash Price |
$3,335.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,817.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,588.03
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$5,559.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,331.00
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$6,452.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$158.25 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,290.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,432.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,331.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,193.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,993.79
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$4,839.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,331.00
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$2,438.65 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$182.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,438.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,577.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$750.14
|
| Rate for Payer: Blue Shield of California Commercial |
$645.50
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,864.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,438.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,438.65
|
| Rate for Payer: Dignity Health Senior |
$2,438.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,864.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,775.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,775.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.25
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,438.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,438.65
|
|
