|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.79
|
| Rate for Payer: Blue Shield of California Commercial |
$549.84
|
| Rate for Payer: Blue Shield of California Commercial |
$362.50
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$607.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$607.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$607.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$454.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$500.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Vantage Medical Group Senior |
$607.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
915353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
915353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.31
|
| Rate for Payer: Blue Shield of California Commercial |
$334.51
|
| Rate for Payer: Blue Shield of California Commercial |
$220.54
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.31
|
| Rate for Payer: Blue Shield of California Commercial |
$334.51
|
| Rate for Payer: Blue Shield of California Commercial |
$220.54
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,955.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,174.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,127.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,203.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,973.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| 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 |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,955.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,174.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,127.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,203.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,973.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| 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 |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna of CA HMO |
$2,027.52
|
| Rate for Payer: Cigna of CA PPO |
$2,344.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,011.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,266.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,584.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,584.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,584.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,267.20
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,011.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,869.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,639.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$527.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cigna of CA HMO |
$1,688.96
|
| Rate for Payer: Cigna of CA PPO |
$1,952.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,847.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$2,243.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,583.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,111.20
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,715.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,243.15
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,583.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,319.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,319.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,639.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$2,243.15 |
| Rate for Payer: Adventist Health Commercial |
$527.80
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,847.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,055.60
|
| Rate for Payer: Galaxy Health WC |
$2,243.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,583.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,557.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.36
|
| Rate for Payer: Multiplan Commercial |
$2,111.20
|
| Rate for Payer: Networks By Design Commercial |
$1,715.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,243.15
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,639.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,081.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$705.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cigna of CA HMO |
$1,688.96
|
| Rate for Payer: Cigna of CA PPO |
$1,952.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,847.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$2,243.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,583.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,111.20
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,715.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,243.15
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,583.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,583.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,639.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$2,243.15 |
| Rate for Payer: Adventist Health Commercial |
$527.80
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,847.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,055.60
|
| Rate for Payer: Galaxy Health WC |
$2,243.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,583.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,557.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.36
|
| Rate for Payer: Multiplan Commercial |
$2,111.20
|
| Rate for Payer: Networks By Design Commercial |
$1,715.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,243.15
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.66
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.70
|
| Rate for Payer: Multiplan Commercial |
$384.80
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.50
|
| Rate for Payer: United Healthcare All Other HMO |
$240.50
|
| Rate for Payer: United Healthcare HMO Rider |
$240.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$384.80
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
OP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$274.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.23
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO |
$267.52
|
| Rate for Payer: Cigna of CA PPO |
$309.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$355.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.60
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$209.00
|
| Rate for Payer: United Healthcare HMO Rider |
$209.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
IP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
|
|
HC EP RF STJ SAFIRE ABLAT CATH
|
Facility
|
OP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$7,775.20 |
| Rate for Payer: Adventist Health Commercial |
$639.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,775.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,758.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,398.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,052.16
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Cigna of CA HMO |
$2,046.72
|
| Rate for Payer: Cigna of CA PPO |
$2,366.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,718.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,718.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,238.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.20
|
| Rate for Payer: Galaxy Health WC |
$2,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,030.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,160.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,886.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,238.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,238.60
|
| Rate for Payer: Multiplan Commercial |
$2,558.40
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,918.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,918.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,599.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,599.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,599.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,599.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,718.30
|
|
|
HC EP RF STJ SAFIRE ABLAT CATH
|
Facility
|
IP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,718.30 |
| Rate for Payer: Adventist Health Commercial |
$639.60
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,238.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.20
|
| Rate for Payer: Galaxy Health WC |
$2,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,030.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,886.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.52
|
| Rate for Payer: Multiplan Commercial |
$2,558.40
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$10,130.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,026.00 |
| Max. Negotiated Rate |
$8,610.50 |
| Rate for Payer: Adventist Health Commercial |
$2,026.00
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,091.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,052.00
|
| Rate for Payer: Galaxy Health WC |
$8,610.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,078.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,432.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,976.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,431.20
|
| Rate for Payer: Multiplan Commercial |
$8,104.00
|
| Rate for Payer: Networks By Design Commercial |
$6,584.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,610.50
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$10,130.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$525.07 |
| Max. Negotiated Rate |
$8,610.50 |
| Rate for Payer: Adventist Health Commercial |
$2,026.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,610.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,571.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cash Price |
$4,558.50
|
| Rate for Payer: Cigna of CA HMO |
$6,483.20
|
| Rate for Payer: Cigna of CA PPO |
$7,496.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,610.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,610.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,610.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,091.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,052.00
|
| Rate for Payer: Galaxy Health WC |
$8,610.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,078.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,432.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,976.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,431.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,091.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,091.00
|
| Rate for Payer: Multiplan Commercial |
$8,104.00
|
| Rate for Payer: Networks By Design Commercial |
$6,584.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,610.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,078.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,078.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,610.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,610.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,610.50
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$6,025.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$5,121.25 |
| Rate for Payer: Adventist Health Commercial |
$1,205.00
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,217.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,825.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,554.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,446.00
|
| Rate for Payer: Multiplan Commercial |
$4,820.00
|
| Rate for Payer: Networks By Design Commercial |
$3,916.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,121.25
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,025.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$297.23 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$1,205.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,193.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cash Price |
$2,711.25
|
| Rate for Payer: Cigna of CA HMO |
$3,856.00
|
| Rate for Payer: Cigna of CA PPO |
$4,458.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,217.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| 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/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,825.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,446.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,973.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,098.39
|
| 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 |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
