|
HC EPSTEIN BARR EARLY ANTIGEN IGG
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$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 BARR NUCLEAR ANTIGEN IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC EPSTEIN BARR NUCLEAR ANTIGEN IGG
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913654
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$153.34 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.34
|
| Rate for Payer: Blue Shield of California Commercial |
$89.65
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.29
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGG
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$159.26 |
| Rate for Payer: EPIC Health Plan Senior |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.26
|
| Rate for Payer: Blue Shield of California Commercial |
$89.65
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGM
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$159.26 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.26
|
| Rate for Payer: Blue Shield of California Commercial |
$89.65
|
| Rate for Payer: Blue Shield of California EPN |
$59.23
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EPSTEIN BARR VIRAL CAPSID IGM
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913656
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.74
|
| 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 |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EP STIMULATION BY MEDICATION
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906811482
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC EP ST J ABLATION CABLE
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
906812640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC EP ST J ABLATION CABLE
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
906812640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC EP ST J COOL POINT TUBING
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
906812643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC EP ST J COOL POINT TUBING
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
906812643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC EP ST J ENSITE PRECISION PATCH
|
Facility
|
OP
|
$3,510.00
|
|
| Hospital Charge Code |
906812730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,302.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,155.49
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cigna of CA HMO |
$2,246.40
|
| Rate for Payer: Cigna of CA PPO |
$2,597.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$2,281.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,755.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,755.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC EP ST J ENSITE PRECISION PATCH
|
Facility
|
IP
|
$3,510.00
|
|
| Hospital Charge Code |
906812730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.40
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$2,281.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
|
|
HC EP ST J LIVEWIRE DECA PURPOSE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC EP ST J LIVEWIRE DECA PURPOSE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC EP ST J LIVEWIRE DECA SUPER LG
|
Facility
|
OP
|
$3,853.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$3,275.05 |
| Rate for Payer: Adventist Health Commercial |
$770.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,527.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,119.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,889.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,366.13
|
| Rate for Payer: Cash Price |
$2,119.15
|
| Rate for Payer: Cigna of CA HMO |
$2,465.92
|
| Rate for Payer: Cigna of CA PPO |
$2,851.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,275.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,275.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,467.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,385.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,697.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,697.10
|
| Rate for Payer: Multiplan Commercial |
$3,082.40
|
| Rate for Payer: Networks By Design Commercial |
$2,504.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,926.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,926.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,926.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,275.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,275.05
|
|
|
HC EP ST J LIVEWIRE DECA SUPER LG
|
Facility
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.60 |
| Max. Negotiated Rate |
$3,275.05 |
| Rate for Payer: Adventist Health Commercial |
$770.60
|
| Rate for Payer: Cash Price |
$2,119.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,541.20
|
| Rate for Payer: Galaxy Health WC |
$3,275.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,467.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,385.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.72
|
| Rate for Payer: Multiplan Commercial |
$3,082.40
|
| Rate for Payer: Networks By Design Commercial |
$2,504.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,275.05
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$7,334.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,466.80 |
| Max. Negotiated Rate |
$6,233.90 |
| Rate for Payer: Adventist Health Commercial |
$1,466.80
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,933.60
|
| Rate for Payer: Galaxy Health WC |
$6,233.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,400.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,891.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,794.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,539.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.16
|
| Rate for Payer: Multiplan Commercial |
$5,867.20
|
| Rate for Payer: Networks By Design Commercial |
$4,767.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,233.90
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$7,546.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$493.85 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,509.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,414.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,150.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,659.50
|
| 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 |
$4,150.30
|
| Rate for Payer: Cash Price |
$4,150.30
|
| Rate for Payer: Cash Price |
$4,150.30
|
| Rate for Payer: Cigna of CA HMO |
$4,829.44
|
| Rate for Payer: Cigna of CA PPO |
$5,584.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,414.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,414.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,414.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,018.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,018.40
|
| Rate for Payer: Galaxy Health WC |
$6,414.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,527.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$493.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,033.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,670.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,811.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,282.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,282.20
|
| Rate for Payer: Multiplan Commercial |
$6,036.80
|
| Rate for Payer: Networks By Design Commercial |
$4,904.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,414.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,527.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,527.60
|
| 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 |
$6,414.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,414.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,414.10
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$7,546.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,509.20 |
| Max. Negotiated Rate |
$6,414.10 |
| Rate for Payer: Adventist Health Commercial |
$1,509.20
|
| Rate for Payer: Cash Price |
$4,150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,018.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,018.40
|
| Rate for Payer: Galaxy Health WC |
$6,414.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,527.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,033.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,875.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,670.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,811.04
|
| Rate for Payer: Multiplan Commercial |
$6,036.80
|
| Rate for Payer: Networks By Design Commercial |
$4,904.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,414.10
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$7,334.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$493.85 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,466.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,033.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,500.50
|
| 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 |
$4,033.70
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: Cash Price |
$4,033.70
|
| Rate for Payer: Cigna of CA HMO |
$4,693.76
|
| Rate for Payer: Cigna of CA PPO |
$5,427.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,233.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,233.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,933.60
|
| Rate for Payer: Galaxy Health WC |
$6,233.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,400.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$493.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,891.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,539.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,133.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,133.80
|
| Rate for Payer: Multiplan Commercial |
$5,867.20
|
| Rate for Payer: Networks By Design Commercial |
$4,767.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,233.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,400.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,400.40
|
| 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 |
$6,233.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,233.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,233.90
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$7,041.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.88 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$1,408.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,618.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: Cigna of CA HMO |
$4,506.24
|
| Rate for Payer: Cigna of CA PPO |
$5,210.34
|
| 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 |
$5,984.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,224.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.84
|
| 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 |
$5,632.80
|
| Rate for Payer: Networks By Design Commercial |
$4,576.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,984.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,224.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,224.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,641.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$7,245.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,449.00 |
| Max. Negotiated Rate |
$6,158.25 |
| Rate for Payer: Adventist Health Commercial |
$1,449.00
|
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,898.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,898.00
|
| Rate for Payer: Galaxy Health WC |
$6,158.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,347.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,832.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,760.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.80
|
| Rate for Payer: Multiplan Commercial |
$5,796.00
|
| Rate for Payer: Networks By Design Commercial |
$4,709.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,158.25
|
|
