|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$13,524.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$11,495.40 |
| Rate for Payer: Adventist Health Commercial |
$2,704.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,357.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,495.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,438.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$6,085.80
|
| Rate for Payer: Cash Price |
$6,085.80
|
| Rate for Payer: Cash Price |
$6,085.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,495.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,495.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,495.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,979.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,371.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8,371.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,450.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,447.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,466.80
|
| Rate for Payer: Multiplan Commercial |
$10,143.00
|
| 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 |
$11,495.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,495.40
|
| Rate for Payer: Vantage Medical Group Senior |
$11,495.40
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$8,773.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,587.91 |
| Max. Negotiated Rate |
$6,579.75 |
| Rate for Payer: Adventist Health Commercial |
$1,754.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,649.81
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,587.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,193.25
|
| Rate for Payer: Multiplan Commercial |
$6,579.75
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$8,773.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,136.00 |
| Rate for Payer: Adventist Health Commercial |
$1,754.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,421.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,825.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,579.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$3,947.85
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Cash Price |
$3,947.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,702.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,457.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,457.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,176.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,430.49
|
| Rate for Payer: Heritage Provider Network Senior |
$5,430.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,184.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,587.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,193.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,141.10
|
| Rate for Payer: Multiplan Commercial |
$6,579.75
|
| 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 |
$7,457.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,457.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,457.05
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$5,506.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,402.71
|
| 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 |
$6,245.00
|
| 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 |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| 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 Medicare Advantage |
$4,680.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,248.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,408.21
|
| Rate for Payer: Heritage Provider Network Senior |
$3,408.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,626.36
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 POST DRUG INFUSION
|
Facility
|
IP
|
$5,506.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
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: Aetna of CA Non-Gatekeeper |
$3,545.86
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 RV RECORDING
|
Facility
|
OP
|
$5,983.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,697.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,692.35
|
| Rate for Payer: Cash Price |
$2,692.35
|
| Rate for Payer: Cash Price |
$2,692.35
|
| Rate for Payer: Cash Price |
$2,692.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,888.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,565.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,703.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,926.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,975.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,082.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,495.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$4,487.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,200.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,200.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$5,983.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,082.92 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,853.05
|
| Rate for Payer: Cash Price |
$2,692.35
|
| Rate for Payer: Cash Price |
$2,692.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,082.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,495.75
|
| Rate for Payer: Multiplan Commercial |
$4,487.25
|
|
|
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: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| 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 Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| 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: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| 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 Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$105.58
|
| Rate for Payer: Blue Shield of California Commercial |
$105.58
|
| Rate for Payer: Blue Shield of California EPN |
$84.68
|
| Rate for Payer: Blue Shield of California EPN |
$84.68
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.12
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$14.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
| 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: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$98.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$147.40 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| 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 Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$123.15
|
| Rate for Payer: Blue Shield of California Commercial |
$123.15
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$16.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
| 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: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$98.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| 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 Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.09
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
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: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals 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 IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| 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 Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.09
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California Commercial |
$140.26
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Blue Shield of California EPN |
$112.50
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
| 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: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$383.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.12
|
| 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 |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$203.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| 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 |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Aetna of CA Non-Gatekeeper |
$399.28
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$3,545.86
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$5,506.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,136.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$3,578.90
|
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,402.71
|
| 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 |
$9,136.00
|
| 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 |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| 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 Medicare Advantage |
$4,680.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,248.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,408.21
|
| Rate for Payer: Heritage Provider Network Senior |
$3,408.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,626.36
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 VENTRICULAR PACING
|
Facility
|
OP
|
$5,506.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$19,060.17 |
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Adventist Health Commercial |
$1,101.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,402.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,047.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,034.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,031.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,578.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,047.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,034.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,031.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,031.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,408.21
|
| Rate for Payer: Heritage Provider Network Senior |
$12,338.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,031.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19,060.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$996.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,536.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,442.44
|
| 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 |
$15,047.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,034.84
|
| Rate for Payer: Vantage Medical Group Senior |
$10,031.67
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,545.86
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Cash Price |
$2,477.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$1,267.39
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.34
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$356.21 |
| Max. Negotiated Rate |
$1,672.80 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,216.22
|
| 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 |
$850.93
|
| 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 |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| 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 Medicare Advantage |
$1,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$938.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
