|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.55
|
| Rate for Payer: Blue Distinction Transplant |
$42.85
|
| Rate for Payer: Blue Shield of California Commercial |
$52.64
|
| Rate for Payer: Blue Shield of California EPN |
$41.71
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Media |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.08
|
| Rate for Payer: Blue Distinction Transplant |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22.36
|
| Rate for Payer: Blue Shield of California EPN |
$17.72
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Media |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.08
|
| Rate for Payer: Blue Distinction Transplant |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$22.36
|
| Rate for Payer: Blue Shield of California EPN |
$17.72
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Media |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$27,649.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$23,501.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$16,589.40
|
| Rate for Payer: Blue Shield of California Commercial |
$16,340.56
|
| Rate for Payer: Blue Shield of California EPN |
$12,967.38
|
| Rate for Payer: Cash Price |
$12,442.05
|
| Rate for Payer: Cash Price |
$12,442.05
|
| Rate for Payer: Cigna of CA HMO |
$17,695.36
|
| Rate for Payer: Cigna of CA PPO |
$20,460.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$23,501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,589.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20,736.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,441.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,635.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$22,119.20
|
| Rate for Payer: Networks By Design Commercial |
$17,971.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,501.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,589.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,589.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13,824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,824.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$27,649.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6,635.76 |
| Max. Negotiated Rate |
$23,501.65 |
| Rate for Payer: Cash Price |
$12,442.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,059.60
|
| Rate for Payer: Galaxy Health WC |
$23,501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,589.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,441.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,534.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,635.76
|
| Rate for Payer: Multiplan Commercial |
$22,119.20
|
| Rate for Payer: Networks By Design Commercial |
$17,971.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,501.65
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$11,892.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,854.08 |
| Max. Negotiated Rate |
$10,108.20 |
| Rate for Payer: Cash Price |
$5,351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,756.80
|
| Rate for Payer: Galaxy Health WC |
$10,108.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,135.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,931.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,530.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,854.08
|
| Rate for Payer: Multiplan Commercial |
$9,513.60
|
| Rate for Payer: Networks By Design Commercial |
$7,729.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,108.20
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$11,892.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,854.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,135.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$5,351.40
|
| Rate for Payer: Cash Price |
$5,351.40
|
| Rate for Payer: Cigna of CA PPO |
$8,800.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,108.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,135.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,919.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,931.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,779.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,854.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,513.60
|
| Rate for Payer: Networks By Design Commercial |
$7,729.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,108.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,135.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$1,395.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$902.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.44
|
| Rate for Payer: Blue Distinction Transplant |
$985.20
|
| Rate for Payer: Blue Shield of California Commercial |
$970.42
|
| Rate for Payer: Blue Shield of California EPN |
$770.10
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cigna of CA HMO |
$1,050.88
|
| Rate for Payer: Cigna of CA PPO |
$1,215.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,395.70
|
| Rate for Payer: Global Benefits Group Commercial |
$985.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,231.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,067.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$985.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$985.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,642.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$394.08 |
| Max. Negotiated Rate |
$1,395.70 |
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.80
|
| Rate for Payer: Galaxy Health WC |
$1,395.70
|
| Rate for Payer: Global Benefits Group Commercial |
$985.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.08
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,067.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,395.70
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$43.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.30
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.68
|
| Rate for Payer: Dignity Health Media |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.79
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$941.76 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,569.60
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.23 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,354.40
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cash Price |
$1,765.80
|
| Rate for Payer: Cigna of CA PPO |
$2,903.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$3,335.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,354.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,943.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,139.20
|
| Rate for Payer: Networks By Design Commercial |
$2,550.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,335.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,354.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,962.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cigna of CA PPO |
$1,998.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$648.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,350.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,350.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.00 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$648.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,487.36 |
| Max. Negotiated Rate |
$8,809.40 |
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.36
|
| Rate for Payer: Multiplan Commercial |
$8,291.20
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$593.83 |
| Max. Negotiated Rate |
$8,809.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$713.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,700.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,700.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,218.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cigna of CA HMO |
$6,632.96
|
| Rate for Payer: Cigna of CA PPO |
$7,669.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Dignity Health Media |
$8,809.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,809.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.36
|
| Rate for Payer: Multiplan Commercial |
$8,291.20
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,218.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,809.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,809.40
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$336.15 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,438.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,408.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,408.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$4,931.20
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,479.36 |
| Max. Negotiated Rate |
$5,239.40 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$4,931.20
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,479.36 |
| Max. Negotiated Rate |
$5,239.40 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$4,931.20
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$201.17 |
| Max. Negotiated Rate |
$15,302.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,331.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Media |
$9,331.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,596.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,331.00
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,302.84
|
| Rate for Payer: Heritage Provider Network Transplant |
$15,302.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,116.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$15,116.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,503.54
|
| Rate for Payer: Multiplan Commercial |
$4,931.20
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| 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 ATRIAL RECORDING
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906811320
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,479.36 |
| Max. Negotiated Rate |
$5,239.40 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$4,931.20
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906811320
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$201.17 |
| Max. Negotiated Rate |
$15,302.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$319.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,331.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Media |
$9,331.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,596.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,331.00
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,302.84
|
| Rate for Payer: Heritage Provider Network Transplant |
$15,302.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,116.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$15,116.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,503.54
|
| Rate for Payer: Multiplan Commercial |
$4,931.20
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| 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
|
|
