|
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 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: AlphaCare Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$24.68
|
| Rate for Payer: 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
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: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare 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: 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
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
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
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: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare 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: 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$5,484.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,548.60
|
| Rate for Payer: AlphaCare 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: 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
|
$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
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 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: AlphaCare Medical Group Commercial/Exchange |
$6,562.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,246.00
|
| Rate for Payer: AlphaCare 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: 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 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
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
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: AlphaCare Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$165.17
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$165.17
|
| Rate for Payer: 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
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.29 |
| Max. Negotiated Rate |
$2,151.75 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,942.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,942.31
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$2,438.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,577.95
|
| Rate for Payer: AlphaCare 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: 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
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.29 |
| Max. Negotiated Rate |
$2,151.75 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,942.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,942.31
|
| 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
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
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 |
$271.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,438.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,577.95
|
| Rate for Payer: AlphaCare 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: 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
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
OP
|
$4,620.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$924.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,173.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,003.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,859.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medi-Cal |
$482.06
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$836.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$3,465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
IP
|
$4,546.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$822.83 |
| Max. Negotiated Rate |
$3,409.50 |
| Rate for Payer: Adventist Health Commercial |
$909.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.10
|
| Rate for Payer: Cash Price |
$2,045.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,077.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,077.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,409.50
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.17 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,770.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3,770.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,008.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,392.50
|
| Rate for Payer: Multiplan Commercial |
$4,177.50
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
OP
|
$6,916.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$13,529.58 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,751.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,495.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,281.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: IEHP Medi-Cal |
$646.99
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
IP
|
$4,613.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$834.95 |
| Max. Negotiated Rate |
$3,459.75 |
| Rate for Payer: Adventist Health Commercial |
$922.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,169.13
|
| Rate for Payer: Cash Price |
$2,075.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,123.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,123.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.25
|
| Rate for Payer: Multiplan Commercial |
$3,459.75
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
OP
|
$8,498.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,699.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,838.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,824.10
|
| Rate for Payer: Cash Price |
$3,824.10
|
| Rate for Payer: Cash Price |
$3,824.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,523.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,260.26
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medi-Cal |
$536.66
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$6,373.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
