|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,639.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$2,243.15 |
| Rate for Payer: Adventist Health Commercial |
$527.80
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,055.60
|
| Rate for Payer: Galaxy Health WC |
$2,243.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,583.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,760.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,633.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.36
|
| Rate for Payer: Multiplan Commercial |
$2,111.20
|
| Rate for Payer: Networks By Design Commercial |
$1,715.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,243.15
|
|
|
HC EP MED TEMP PACING SCREW-IN
|
Facility
|
IP
|
$1,288.00
|
|
| Hospital Charge Code |
906812351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Adventist Health Commercial |
$257.60
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$515.20
|
| Rate for Payer: Galaxy Health WC |
$1,094.80
|
| Rate for Payer: Global Benefits Group Commercial |
$772.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$859.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$797.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.12
|
| Rate for Payer: Multiplan Commercial |
$1,030.40
|
| Rate for Payer: Networks By Design Commercial |
$837.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,094.80
|
|
|
HC EP MED TEMP PACING SCREW-IN
|
Facility
|
OP
|
$1,288.00
|
|
| Hospital Charge Code |
906812351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Adventist Health Commercial |
$257.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,094.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$966.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$790.96
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna of CA HMO |
$824.32
|
| Rate for Payer: Cigna of CA PPO |
$953.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,094.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,094.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$515.20
|
| Rate for Payer: Galaxy Health WC |
$1,094.80
|
| Rate for Payer: Global Benefits Group Commercial |
$772.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$859.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$797.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$901.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$901.60
|
| Rate for Payer: Multiplan Commercial |
$1,030.40
|
| Rate for Payer: Networks By Design Commercial |
$837.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,094.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$772.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$772.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.00
|
| Rate for Payer: United Healthcare All Other HMO |
$644.00
|
| Rate for Payer: United Healthcare HMO Rider |
$644.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,094.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,094.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,094.80
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.38
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.70
|
| Rate for Payer: Multiplan Commercial |
$384.80
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.50
|
| Rate for Payer: United Healthcare All Other HMO |
$240.50
|
| Rate for Payer: United Healthcare HMO Rider |
$240.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$384.80
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
IP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
OP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$274.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.69
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO |
$267.52
|
| Rate for Payer: Cigna of CA PPO |
$309.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.60
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$209.00
|
| Rate for Payer: United Healthcare HMO Rider |
$209.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
|
HC EP RF ST J FLEXABILITY D-F
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
|
|
HC EP RF ST J FLEXABILITY D-F
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,705.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,533.16
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO |
$2,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,052.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,887.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC EP RF ST J FLEXABILITY F-J
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,705.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,533.16
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO |
$2,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,052.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,887.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC EP RF ST J FLEXABILITY F-J
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$990.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
|
|
HC EP RF STJ SAFIRE ABLAT CATH
|
Facility
|
OP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,718.30 |
| Rate for Payer: Adventist Health Commercial |
$639.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,097.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,758.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,398.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,963.89
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Cigna of CA HMO |
$2,046.72
|
| Rate for Payer: Cigna of CA PPO |
$2,366.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,718.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,718.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.20
|
| Rate for Payer: Galaxy Health WC |
$2,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,133.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,979.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,238.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,238.60
|
| Rate for Payer: Multiplan Commercial |
$2,558.40
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,918.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,918.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,599.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,599.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,599.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,599.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,718.30
|
|
|
HC EP RF STJ SAFIRE ABLAT CATH
|
Facility
|
IP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,718.30 |
| Rate for Payer: Adventist Health Commercial |
$639.60
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.20
|
| Rate for Payer: Galaxy Health WC |
$2,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,133.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,979.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Multiplan Commercial |
$2,558.40
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$9,846.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$525.07 |
| Max. Negotiated Rate |
$8,369.10 |
| Rate for Payer: Adventist Health Commercial |
$1,969.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,457.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,369.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,415.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,384.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,430.70
|
| Rate for Payer: Cash Price |
$4,430.70
|
| Rate for Payer: Cash Price |
$4,430.70
|
| Rate for Payer: Cigna of CA HMO |
$6,301.44
|
| Rate for Payer: Cigna of CA PPO |
$7,286.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,369.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,369.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,938.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,938.40
|
| Rate for Payer: Galaxy Health WC |
$8,369.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,567.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,094.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,363.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,892.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,892.20
|
| Rate for Payer: Multiplan Commercial |
$7,876.80
|
| Rate for Payer: Networks By Design Commercial |
$6,399.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,369.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,907.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,907.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,369.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,369.10
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$9,846.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,969.20 |
| Max. Negotiated Rate |
$8,369.10 |
| Rate for Payer: Adventist Health Commercial |
$1,969.20
|
| Rate for Payer: Cash Price |
$4,430.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,938.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,938.40
|
| Rate for Payer: Galaxy Health WC |
$8,369.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,567.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,751.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,094.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,363.04
|
| Rate for Payer: Multiplan Commercial |
$7,876.80
|
| Rate for Payer: Networks By Design Commercial |
$6,399.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,369.10
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$10,130.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$525.07 |
| Max. Negotiated Rate |
$8,610.50 |
| Rate for Payer: Adventist Health Commercial |
$2,026.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,644.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,610.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,571.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cigna of CA HMO |
$6,483.20
|
| Rate for Payer: Cigna of CA PPO |
$7,496.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,610.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,610.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,610.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,052.00
|
| Rate for Payer: Galaxy Health WC |
$8,610.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,078.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,756.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,270.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,431.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,091.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,091.00
|
| Rate for Payer: Multiplan Commercial |
$8,104.00
|
| Rate for Payer: Networks By Design Commercial |
$6,584.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,610.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,078.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,078.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,610.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,610.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,610.50
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$10,130.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,026.00 |
| Max. Negotiated Rate |
$8,610.50 |
| Rate for Payer: Adventist Health Commercial |
$2,026.00
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,052.00
|
| Rate for Payer: Galaxy Health WC |
$8,610.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,078.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,756.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,859.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,270.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,431.20
|
| Rate for Payer: Multiplan Commercial |
$8,104.00
|
| Rate for Payer: Networks By Design Commercial |
$6,584.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,610.50
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$297.23 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna of CA HMO |
$3,747.84
|
| Rate for Payer: Cigna of CA PPO |
$4,333.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$4,684.80
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,171.20 |
| Max. Negotiated Rate |
$4,977.60 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,342.40
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,231.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,624.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.44
|
| Rate for Payer: Multiplan Commercial |
$4,684.80
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$6,025.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$5,121.25 |
| Rate for Payer: Adventist Health Commercial |
$1,205.00
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.00
|
| Rate for Payer: Galaxy Health WC |
$5,121.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,615.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,018.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,295.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,729.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,446.00
|
| Rate for Payer: Multiplan Commercial |
$4,820.00
|
| Rate for Payer: Networks By Design Commercial |
$3,916.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,121.25
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,025.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$297.23 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,205.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cigna of CA HMO |
$3,856.00
|
| Rate for Payer: Cigna of CA PPO |
$4,458.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$5,121.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,615.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,018.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,446.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$4,820.00
|
| Rate for Payer: Networks By Design Commercial |
$3,916.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,121.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,615.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,615.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ARTERIAL CATH SET
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
906811777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC EPS ARTERIAL CATH SET
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
906811777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,171.20 |
| Max. Negotiated Rate |
$4,977.60 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,342.40
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,231.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,624.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.44
|
| Rate for Payer: Multiplan Commercial |
$4,684.80
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.88 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,840.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna of CA HMO |
$3,747.84
|
| Rate for Payer: Cigna of CA PPO |
$4,333.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,015.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9,641.44
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,919.53
|
| Rate for Payer: Multiplan Commercial |
$4,684.80
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,641.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
