|
HC EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| 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 |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| 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 |
$50.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| 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 |
$57.75
|
| 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
|
$77.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC EPSTEIN BARR EARLY ANTIGEN IGG
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| 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 |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| 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 |
$50.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| 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 |
$36.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| 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 |
$57.75
|
| 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 EARLY ANTIGEN IGG
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC EPSTEIN BARR NUCLEAR ANTIGEN IGG
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$141.73 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| 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 |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| 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 |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| 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 |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| 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 |
$100.50
|
| 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 EPSTEIN BARR NUCLEAR ANTIGEN IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| 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 |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| 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 |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| 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 |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| 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 |
$100.50
|
| 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 EPSTEIN BARR VIRAL CAPSID IGM
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| 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 |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| 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 |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| 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 |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| 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 |
$100.50
|
| 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 EPSTEIN BARR VIRAL CAPSID IGM
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$331.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820014
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$146.00
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cash Price |
$401.50
|
| 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 |
$132.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.50
|
| Rate for Payer: Multiplan Commercial |
$547.50
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820014
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$146.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$390.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$474.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$451.87
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$547.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| 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 |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$5,506.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,782.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,129.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| 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 |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,578.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.10
|
| Rate for Payer: Dignity Health Senior |
$4,680.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,578.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,408.21
|
| Rate for Payer: Heritage Provider Network Senior |
$3,408.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$476.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,626.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,854.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,854.20
|
| Rate for Payer: Multiplan Commercial |
$4,129.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,680.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.10
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$7,334.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,327.45 |
| Max. Negotiated Rate |
$5,500.50 |
| Rate for Payer: Adventist Health Commercial |
$1,466.80
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: Cash Price |
$4,033.70
|
| 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 |
$1,327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,833.50
|
| Rate for Payer: Multiplan Commercial |
$5,500.50
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$5,506.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$996.59 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| 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 |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.50
|
| Rate for Payer: Multiplan Commercial |
$4,129.50
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$7,334.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,466.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,038.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,033.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,500.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| 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 |
$4,033.70
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,767.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,233.90
|
| Rate for Payer: Dignity Health Senior |
$6,233.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,767.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,539.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,539.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$476.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,498.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,833.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,133.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,133.80
|
| Rate for Payer: Multiplan Commercial |
$5,500.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,233.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,233.90
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$5,506.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$996.59 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| 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 |
$996.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.50
|
| Rate for Payer: Multiplan Commercial |
$4,129.50
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$7,041.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,274.42 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,408.20
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cash Price |
$3,872.55
|
| 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 |
$1,274.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.25
|
| Rate for Payer: Multiplan Commercial |
$5,280.75
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$7,041.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,408.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,763.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,837.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| 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 |
$3,872.55
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,576.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,358.38
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,274.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$5,280.75
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$5,506.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,942.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,782.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| 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 |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cash Price |
$3,028.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,578.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,408.21
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$4,129.50
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$356.21 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.51 |
| Max. Negotiated Rate |
$1,672.80 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,051.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.20
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,672.80
|
| Rate for Payer: Dignity Health Senior |
$1,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$938.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,377.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,377.60
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,672.80
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$2,351.25 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,122.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,122.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.75
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
|
