|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$709.50
|
| Rate for Payer: Heritage Provider Network Senior |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$639.28
|
| Rate for Payer: Blue Shield of California EPN |
$511.42
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Senior |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.71
|
| Rate for Payer: Heritage Provider Network Senior |
$648.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$245.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$499.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$524.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,927.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,103.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,542.75
|
| Rate for Payer: Cash Price |
$1,542.75
|
| Rate for Payer: Cash Price |
$1,542.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,823.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,384.25
|
| Rate for Payer: Dignity Health Senior |
$2,384.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,736.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,736.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,337.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$507.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,963.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,963.50
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,384.25
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.70 |
| Max. Negotiated Rate |
$2,103.75 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Cash Price |
$1,542.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,898.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,898.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$507.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.25
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$181.78
|
| Rate for Payer: Blue Shield of California EPN |
$145.42
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Senior |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$142.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$149.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Adventist Health Commercial |
$63.20
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.93
|
| Rate for Payer: Heritage Provider Network Senior |
$213.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$63.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$268.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$192.76
|
| Rate for Payer: Blue Shield of California EPN |
$154.21
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cash Price |
$173.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$268.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$268.60
|
| Rate for Payer: Dignity Health Senior |
$268.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Senior |
$195.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$677.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.20
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$158.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$268.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$268.60
|
| Rate for Payer: Vantage Medical Group Senior |
$268.60
|
|
|
HC EBER
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC EBER
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$366.48 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.32
|
| Rate for Payer: Blue Shield of California Commercial |
$366.48
|
| Rate for Payer: Blue Shield of California EPN |
$294.71
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$621.82 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$227.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.82
|
| Rate for Payer: Blue Shield of California Commercial |
$395.33
|
| Rate for Payer: Blue Shield of California EPN |
$317.91
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$276.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.10
|
| Rate for Payer: Dignity Health Senior |
$362.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.69
|
| Rate for Payer: Heritage Provider Network Senior |
$263.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.20
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$114.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$114.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.10
|
| Rate for Payer: Vantage Medical Group Senior |
$362.10
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.40
|
| Rate for Payer: Heritage Provider Network Senior |
$288.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
|
|
HC EBNA IGG
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.73
|
| Rate for Payer: Blue Shield of California Commercial |
$123.15
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Senior |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| 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 |
$202.50
|
| 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 |
$22.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC EBNA IGG
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
|
IP
|
$3,309.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$598.93 |
| Max. Negotiated Rate |
$2,481.75 |
| Rate for Payer: Adventist Health Commercial |
$661.80
|
| Rate for Payer: Cash Price |
$1,819.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,240.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2,240.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$2,481.75
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
|
OP
|
$3,309.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$661.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,273.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,819.95
|
| Rate for Payer: Cash Price |
$1,819.95
|
| Rate for Payer: Cash Price |
$1,819.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,150.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,985.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,048.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$999.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$2,481.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC EBV DNA PCR TEST
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.14
|
| Rate for Payer: Heritage Provider Network Senior |
$89.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV DNA PCR TEST
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.49
|
| Rate for Payer: Heritage Provider Network Senior |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
|
|
HC EBV IGG EARLY AB
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.28
|
| Rate for Payer: Heritage Provider Network Senior |
$62.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
|
|
HC EBV IGG EARLY AB
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.20
|
| 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 |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.58
|
| Rate for Payer: Blue Shield of California EPN |
$84.68
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| 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 |
$59.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| 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 |
$69.00
|
| 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 EBV PCR
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$316.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV PCR
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| 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 |
$147.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| 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 |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| 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 |
$202.50
|
| 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 EBV-VCA IGG/IGM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC ECG 48 HR MONITOR-RECORDING
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$966.75 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$708.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$872.65
|
| Rate for Payer: Heritage Provider Network Senior |
$872.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
|
