|
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 |
$3,313.75
|
| Rate for Payer: Cash Price |
$3,313.75
|
| Rate for Payer: Cash Price |
$3,313.75
|
| 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 |
$3,313.75
|
| 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 |
$6,705.60
|
| Rate for Payer: Cash Price |
$6,705.60
|
| Rate for Payer: Cash Price |
$6,705.60
|
| 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
|
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 |
$5,699.65
|
| 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 |
$6,705.60
|
| 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 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 |
$5,699.65
|
| Rate for Payer: Cash Price |
$5,699.65
|
| Rate for Payer: Cash Price |
$5,699.65
|
| 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 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 |
$7,438.20
|
| Rate for Payer: Cash Price |
$7,438.20
|
| Rate for Payer: Cash Price |
$7,438.20
|
| 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
|
|
|
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 |
$8,751.05
|
| Rate for Payer: Cash Price |
$8,751.05
|
| Rate for Payer: Cash Price |
$8,751.05
|
| 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 |
$7,438.20
|
| 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
|
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 |
$8,751.05
|
| 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 LV PACING & RECORDING
|
Facility
|
IP
|
$8,773.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,754.60 |
| Max. Negotiated Rate |
$7,457.05 |
| Rate for Payer: Adventist Health Commercial |
$1,754.60
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,509.20
|
| Rate for Payer: Galaxy Health WC |
$7,457.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,263.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,342.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,430.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,105.52
|
| Rate for Payer: Multiplan Commercial |
$7,018.40
|
| Rate for Payer: Networks By Design Commercial |
$5,702.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,457.05
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$10,321.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,676.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,740.75
|
| 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 |
$5,676.55
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: Cigna of CA HMO |
$6,605.44
|
| Rate for Payer: Cigna of CA PPO |
$7,637.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,772.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,772.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,128.40
|
| Rate for Payer: Galaxy Health WC |
$8,772.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,192.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,884.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,388.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,224.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,224.70
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,192.60
|
| 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 |
$8,772.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,772.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,772.85
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$10,321.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,064.20 |
| Max. Negotiated Rate |
$8,772.85 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Cash Price |
$5,676.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,128.40
|
| Rate for Payer: Galaxy Health WC |
$8,772.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,884.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,932.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,388.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,477.04
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$8,773.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,754.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,825.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,579.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$4,825.15
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna of CA HMO |
$5,614.72
|
| Rate for Payer: Cigna of CA PPO |
$6,492.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,457.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,457.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,509.20
|
| Rate for Payer: Galaxy Health WC |
$7,457.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,263.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,174.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,851.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,430.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,105.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,141.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,141.10
|
| Rate for Payer: Multiplan Commercial |
$7,018.40
|
| Rate for Payer: Networks By Design Commercial |
$5,702.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,457.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,263.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,263.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,457.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,457.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,457.05
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,320.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,264.00 |
| Max. Negotiated Rate |
$9,622.00 |
| Rate for Payer: Adventist Health Commercial |
$2,264.00
|
| Rate for Payer: Cash Price |
$6,226.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,528.00
|
| Rate for Payer: Galaxy Health WC |
$9,622.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,312.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,007.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,716.80
|
| Rate for Payer: Multiplan Commercial |
$9,056.00
|
| Rate for Payer: Networks By Design Commercial |
$7,358.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,622.00
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,351.70 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,216.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,051.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,251.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$6,051.10
|
| Rate for Payer: Cash Price |
$6,051.10
|
| Rate for Payer: Cigna of CA HMO |
$7,041.28
|
| Rate for Payer: Cigna of CA PPO |
$8,141.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,351.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,351.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,701.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,701.40
|
| Rate for Payer: Multiplan Commercial |
$8,801.60
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,601.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,351.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,351.70
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,200.40 |
| Max. Negotiated Rate |
$9,351.70 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Cash Price |
$6,051.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.48
|
| Rate for Payer: Multiplan Commercial |
$8,801.60
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,320.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,622.00 |
| Rate for Payer: Adventist Health Commercial |
$2,264.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,424.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,622.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,226.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,490.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$6,226.00
|
| Rate for Payer: Cash Price |
$6,226.00
|
| Rate for Payer: Cigna of CA HMO |
$7,244.80
|
| Rate for Payer: Cigna of CA PPO |
$8,376.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,622.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,622.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,622.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,528.00
|
| Rate for Payer: Galaxy Health WC |
$9,622.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,007.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,716.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,924.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,924.00
|
| Rate for Payer: Multiplan Commercial |
$9,056.00
|
| Rate for Payer: Networks By Design Commercial |
$7,358.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,622.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,792.00
|
| 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 |
$9,622.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,622.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,622.00
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,039.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$267.64 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,616.88
|
| 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 |
$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 |
$3,871.45
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: Cigna of CA HMO |
$4,504.96
|
| Rate for Payer: Cigna of CA PPO |
$5,208.86
|
| 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 |
$5,983.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,223.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.36
|
| 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 |
$5,631.20
|
| Rate for Payer: Networks By Design Commercial |
$4,575.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,983.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,223.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,223.40
|
| 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: 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 RV RECORDING
|
Facility
|
IP
|
$7,039.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,407.80 |
| Max. Negotiated Rate |
$5,983.15 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Cash Price |
$3,871.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,815.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,815.60
|
| Rate for Payer: Galaxy Health WC |
$5,983.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,223.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,681.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,357.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.36
|
| Rate for Payer: Multiplan Commercial |
$5,631.20
|
| Rate for Payer: Networks By Design Commercial |
$4,575.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,983.15
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,242.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,448.40 |
| Max. Negotiated Rate |
$6,155.70 |
| Rate for Payer: Adventist Health Commercial |
$1,448.40
|
| Rate for Payer: Cash Price |
$3,983.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,896.80
|
| Rate for Payer: Galaxy Health WC |
$6,155.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,345.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,830.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,759.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.08
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: Networks By Design Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,155.70
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,242.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$267.64 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,448.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,750.03
|
| 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 |
$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 |
$3,983.10
|
| Rate for Payer: Cash Price |
$3,983.10
|
| Rate for Payer: Cash Price |
$3,983.10
|
| Rate for Payer: Cigna of CA HMO |
$4,634.88
|
| Rate for Payer: Cigna of CA PPO |
$5,359.08
|
| 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 |
$6,155.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,345.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,830.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.08
|
| 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 |
$5,793.60
|
| Rate for Payer: Networks By Design Commercial |
$4,707.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,155.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,345.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,345.20
|
| 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 |
$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 EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC EPSTEIN ANTIBODY SCREEN IGM
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900913657
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC EPSTEIN BARR EARLY ANTIGEN IGG
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.58
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10.63
|
| Rate for Payer: United Healthcare HMO Rider |
$10.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
