|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
|
OP
|
$55,683.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906820251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,479.19 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$11,136.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$25,057.35
|
| Rate for Payer: Cash Price |
$25,057.35
|
| Rate for Payer: Cash Price |
$25,057.35
|
| Rate for Payer: Cigna of CA HMO |
$36,193.95
|
| Rate for Payer: Cigna of CA PPO |
$41,205.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,080.50
|
| Rate for Payer: EPIC Health Plan Senior |
$31,170.74
|
| Rate for Payer: Galaxy Health WC |
$47,330.55
|
| Rate for Payer: Global Benefits Group Commercial |
$33,409.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,120.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,479.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37,140.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,170.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,363.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,768.79
|
| Rate for Payer: Multiplan Commercial |
$44,546.40
|
| Rate for Payer: Networks By Design Commercial |
$36,193.95
|
| Rate for Payer: Prime Health Services Commercial |
$47,330.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33,409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31,170.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
OP
|
$40,389.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906811445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,107.89 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$8,077.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$18,175.05
|
| Rate for Payer: Cash Price |
$18,175.05
|
| Rate for Payer: Cash Price |
$18,175.05
|
| Rate for Payer: Cigna of CA HMO |
$26,252.85
|
| Rate for Payer: Cigna of CA PPO |
$29,887.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,080.50
|
| Rate for Payer: EPIC Health Plan Senior |
$31,170.74
|
| Rate for Payer: Galaxy Health WC |
$34,330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$24,233.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,120.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,107.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,939.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,170.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,693.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,768.79
|
| Rate for Payer: Multiplan Commercial |
$32,311.20
|
| Rate for Payer: Networks By Design Commercial |
$26,252.85
|
| Rate for Payer: Prime Health Services Commercial |
$34,330.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,233.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,233.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31,170.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
OP
|
$39,253.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906820248
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,107.89 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,850.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$17,663.85
|
| Rate for Payer: Cash Price |
$17,663.85
|
| Rate for Payer: Cash Price |
$17,663.85
|
| Rate for Payer: Cigna of CA HMO |
$25,514.45
|
| Rate for Payer: Cigna of CA PPO |
$29,047.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,080.50
|
| Rate for Payer: EPIC Health Plan Senior |
$31,170.74
|
| Rate for Payer: Galaxy Health WC |
$33,365.05
|
| Rate for Payer: Global Benefits Group Commercial |
$23,551.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,120.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,107.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,181.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,252.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,170.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,420.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,768.79
|
| Rate for Payer: Multiplan Commercial |
$31,402.40
|
| Rate for Payer: Networks By Design Commercial |
$25,514.45
|
| Rate for Payer: Prime Health Services Commercial |
$33,365.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,551.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,551.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31,170.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
IP
|
$39,253.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906820248
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,850.60 |
| Max. Negotiated Rate |
$33,365.05 |
| Rate for Payer: Adventist Health Commercial |
$7,850.60
|
| Rate for Payer: Cash Price |
$17,663.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,701.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,701.20
|
| Rate for Payer: Galaxy Health WC |
$33,365.05
|
| Rate for Payer: Global Benefits Group Commercial |
$23,551.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,181.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,955.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,297.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,420.72
|
| Rate for Payer: Multiplan Commercial |
$31,402.40
|
| Rate for Payer: Networks By Design Commercial |
$25,514.45
|
| Rate for Payer: Prime Health Services Commercial |
$33,365.05
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
IP
|
$40,389.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906811445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,077.80 |
| Max. Negotiated Rate |
$34,330.65 |
| Rate for Payer: Adventist Health Commercial |
$8,077.80
|
| Rate for Payer: Cash Price |
$18,175.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$16,155.60
|
| Rate for Payer: Galaxy Health WC |
$34,330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$24,233.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,939.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,388.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,000.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,693.36
|
| Rate for Payer: Multiplan Commercial |
$32,311.20
|
| Rate for Payer: Networks By Design Commercial |
$26,252.85
|
| Rate for Payer: Prime Health Services Commercial |
$34,330.65
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
IP
|
$36,546.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906820249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,309.20 |
| Max. Negotiated Rate |
$31,064.10 |
| Rate for Payer: Adventist Health Commercial |
$7,309.20
|
| Rate for Payer: Cash Price |
$16,445.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,618.40
|
| Rate for Payer: Galaxy Health WC |
$31,064.10
|
| Rate for Payer: Global Benefits Group Commercial |
$21,927.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,376.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,924.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,621.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,771.04
|
| Rate for Payer: Multiplan Commercial |
$29,236.80
|
| Rate for Payer: Networks By Design Commercial |
$23,754.90
|
| Rate for Payer: Prime Health Services Commercial |
$31,064.10
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
OP
|
$36,546.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906820249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,478.77 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,309.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$16,445.70
|
| Rate for Payer: Cash Price |
$16,445.70
|
| Rate for Payer: Cash Price |
$16,445.70
|
| Rate for Payer: Cigna of CA HMO |
$23,754.90
|
| Rate for Payer: Cigna of CA PPO |
$27,044.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,080.50
|
| Rate for Payer: EPIC Health Plan Senior |
$31,170.74
|
| Rate for Payer: Galaxy Health WC |
$31,064.10
|
| Rate for Payer: Global Benefits Group Commercial |
$21,927.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,120.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,478.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,376.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,170.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,771.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,768.79
|
| Rate for Payer: Multiplan Commercial |
$29,236.80
|
| Rate for Payer: Networks By Design Commercial |
$23,754.90
|
| Rate for Payer: Prime Health Services Commercial |
$31,064.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,927.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,927.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31,170.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
IP
|
$37,604.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906811446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,520.80 |
| Max. Negotiated Rate |
$31,963.40 |
| Rate for Payer: Adventist Health Commercial |
$7,520.80
|
| Rate for Payer: Cash Price |
$16,921.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,041.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,041.60
|
| Rate for Payer: Galaxy Health WC |
$31,963.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22,562.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,327.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,276.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,024.96
|
| Rate for Payer: Multiplan Commercial |
$30,083.20
|
| Rate for Payer: Networks By Design Commercial |
$24,442.60
|
| Rate for Payer: Prime Health Services Commercial |
$31,963.40
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
OP
|
$37,604.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906811446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,478.77 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,520.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$16,921.80
|
| Rate for Payer: Cash Price |
$16,921.80
|
| Rate for Payer: Cash Price |
$16,921.80
|
| Rate for Payer: Cigna of CA HMO |
$24,442.60
|
| Rate for Payer: Cigna of CA PPO |
$27,826.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,080.50
|
| Rate for Payer: EPIC Health Plan Senior |
$31,170.74
|
| Rate for Payer: Galaxy Health WC |
$31,963.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22,562.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,120.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,478.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,170.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,024.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,768.79
|
| Rate for Payer: Multiplan Commercial |
$30,083.20
|
| Rate for Payer: Networks By Design Commercial |
$24,442.60
|
| Rate for Payer: Prime Health Services Commercial |
$31,963.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,562.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,562.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31,170.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
IP
|
$6,025.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906811326
|
|
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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$6,025.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906811326
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,205.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,951.80
|
| 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 |
$137.76
|
| 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 |
$155.80
|
| 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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$6,906.11 |
| 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 |
$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 |
$137.76
|
| 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 |
$155.80
|
| 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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906820046
|
|
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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906820046
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.05 |
| Max. Negotiated Rate |
$6,906.11 |
| 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 |
$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 |
$157.05
|
| 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 |
$177.61
|
| 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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
OP
|
$6,025.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906811327
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.05 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,205.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,951.80
|
| 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 |
$157.05
|
| 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 |
$177.61
|
| 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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
IP
|
$6,025.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906811327
|
|
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 FOLLOW-UP STUDY
|
Facility
|
OP
|
$12,192.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906820037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$479.84 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$2,438.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,996.73
|
| 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 |
$8,922.00
|
| 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 |
$5,486.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cigna of CA HMO |
$7,802.88
|
| Rate for Payer: Cigna of CA PPO |
$9,022.08
|
| 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 |
$10,363.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,315.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$479.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,132.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,926.08
|
| 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 |
$9,753.60
|
| Rate for Payer: Networks By Design Commercial |
$7,924.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,363.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,315.20
|
| 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
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
OP
|
$10,363.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906811304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$479.84 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$2,072.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,797.09
|
| 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 |
$8,922.00
|
| 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 |
$4,663.35
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cigna of CA HMO |
$6,632.32
|
| Rate for Payer: Cigna of CA PPO |
$7,668.62
|
| 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 |
$8,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,217.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$479.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.12
|
| 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 |
$8,290.40
|
| Rate for Payer: Networks By Design Commercial |
$6,735.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,808.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,217.80
|
| 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
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
IP
|
$10,363.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906811304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,072.60 |
| Max. Negotiated Rate |
$8,808.55 |
| Rate for Payer: Adventist Health Commercial |
$2,072.60
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,145.20
|
| Rate for Payer: Galaxy Health WC |
$8,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,414.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.12
|
| Rate for Payer: Multiplan Commercial |
$8,290.40
|
| Rate for Payer: Networks By Design Commercial |
$6,735.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,808.55
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
IP
|
$12,192.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906820037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,438.40 |
| Max. Negotiated Rate |
$10,363.20 |
| Rate for Payer: Adventist Health Commercial |
$2,438.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,876.80
|
| Rate for Payer: Galaxy Health WC |
$10,363.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,315.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,132.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,645.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,546.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,926.08
|
| Rate for Payer: Multiplan Commercial |
$9,753.60
|
| Rate for Payer: Networks By Design Commercial |
$7,924.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,363.20
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$15,911.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906820048
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,182.20 |
| Max. Negotiated Rate |
$13,524.35 |
| Rate for Payer: Adventist Health Commercial |
$3,182.20
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,364.40
|
| Rate for Payer: Galaxy Health WC |
$13,524.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,546.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,612.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,062.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,848.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,818.64
|
| Rate for Payer: Multiplan Commercial |
$12,728.80
|
| Rate for Payer: Networks By Design Commercial |
$10,342.15
|
| Rate for Payer: Prime Health Services Commercial |
$13,524.35
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$15,911.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906820048
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$13,524.35 |
| Rate for Payer: Adventist Health Commercial |
$3,182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,524.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,751.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,933.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| 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 |
$7,159.95
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: Cigna of CA HMO |
$10,183.04
|
| Rate for Payer: Cigna of CA PPO |
$11,774.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,524.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,524.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,524.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,364.40
|
| Rate for Payer: Galaxy Health WC |
$13,524.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,546.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,612.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,848.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,818.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,137.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,137.70
|
| Rate for Payer: Multiplan Commercial |
$12,728.80
|
| Rate for Payer: Networks By Design Commercial |
$10,342.15
|
| Rate for Payer: Prime Health Services Commercial |
$13,524.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,546.60
|
| 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 |
$13,524.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,524.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,524.35
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$13,524.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,704.80 |
| Max. Negotiated Rate |
$11,495.40 |
| Rate for Payer: Adventist Health Commercial |
$2,704.80
|
| Rate for Payer: Cash Price |
$6,085.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,409.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,409.60
|
| Rate for Payer: Galaxy Health WC |
$11,495.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,114.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,152.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,371.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.76
|
| Rate for Payer: Multiplan Commercial |
$10,819.20
|
| Rate for Payer: Networks By Design Commercial |
$8,790.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,495.40
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$13,524.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,495.40 |
| Rate for Payer: Adventist Health Commercial |
$2,704.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,495.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,438.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| 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 |
$6,085.80
|
| Rate for Payer: Cash Price |
$6,085.80
|
| Rate for Payer: Cash Price |
$6,085.80
|
| Rate for Payer: Cigna of CA HMO |
$8,655.36
|
| Rate for Payer: Cigna of CA PPO |
$10,007.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,495.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,495.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,495.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,409.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,409.60
|
| Rate for Payer: Galaxy Health WC |
$11,495.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,114.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,371.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,245.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,466.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,466.80
|
| Rate for Payer: Multiplan Commercial |
$10,819.20
|
| Rate for Payer: Networks By Design Commercial |
$8,790.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,495.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,114.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,114.40
|
| 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 |
$11,495.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,495.40
|
| Rate for Payer: Vantage Medical Group Senior |
$11,495.40
|
|
