|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906811326
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$141.04 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,023.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,410.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,923.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,982.40
|
| Rate for Payer: Cigna of CA HMO |
$3,185.92
|
| Rate for Payer: Cigna of CA PPO |
$3,683.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,480.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,320.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,986.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,986.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,171.20 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,342.40
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,270.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,231.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,624.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.20
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
|
|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$141.04 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,556.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,835.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,439.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,684.80
|
| Rate for Payer: Cigna of CA HMO |
$3,747.84
|
| Rate for Payer: Cigna of CA PPO |
$4,333.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,270.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906811327
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$995.60 |
| Max. Negotiated Rate |
$4,480.20 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,982.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,991.20
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,480.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,320.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,896.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,081.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.60
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
|
|
HC EPS ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906820046
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$160.79 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,556.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,835.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,439.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,684.80
|
| Rate for Payer: Cigna of CA HMO |
$3,747.84
|
| Rate for Payer: Cigna of CA PPO |
$4,333.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,270.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906820046
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,171.20 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,342.40
|
| Rate for Payer: Galaxy Health WC |
$4,977.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,270.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,905.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,231.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,624.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.20
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| Rate for Payer: Networks By Design Commercial |
$3,806.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,977.60
|
|
|
HC EPS ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906811327
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$160.79 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,023.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,410.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,923.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,982.40
|
| Rate for Payer: Cigna of CA HMO |
$3,185.92
|
| Rate for Payer: Cigna of CA PPO |
$3,683.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,480.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,320.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,986.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,986.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
OP
|
$12,192.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906820037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$491.27 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$2,438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,641.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,404.20
|
| 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 Exchange |
$5,903.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,160.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,753.60
|
| Rate for Payer: Cigna of CA HMO |
$7,802.88
|
| Rate for Payer: Cigna of CA PPO |
$9,022.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,015.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9,641.44
|
| Rate for Payer: Galaxy Health WC |
$10,363.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,972.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$491.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14,462.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,132.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,919.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,919.53
|
| Rate for Payer: Multiplan Commercial |
$9,144.00
|
| Rate for Payer: Networks By Design Commercial |
$7,924.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Prime Health Services Commercial |
$10,363.20
|
| Rate for Payer: Prime Health Services Medicare |
$10,219.93
|
| Rate for Payer: Riverside University Health System MISP |
$10,605.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,315.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,641.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
OP
|
$14,021.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906811304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$491.27 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$2,804.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,641.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,514.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,788.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,234.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,309.45
|
| Rate for Payer: Cash Price |
$6,309.45
|
| Rate for Payer: Cash Price |
$6,309.45
|
| Rate for Payer: Central Health Plan Commercial |
$11,216.80
|
| Rate for Payer: Cigna of CA HMO |
$8,973.44
|
| Rate for Payer: Cigna of CA PPO |
$10,375.54
|
| 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 |
$11,917.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,412.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,618.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$491.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14,462.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,804.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,919.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,919.53
|
| Rate for Payer: Multiplan Commercial |
$10,515.75
|
| Rate for Payer: Networks By Design Commercial |
$9,113.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Prime Health Services Commercial |
$11,917.85
|
| Rate for Payer: Prime Health Services Medicare |
$10,219.93
|
| Rate for Payer: Riverside University Health System MISP |
$10,605.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,412.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,412.60
|
| 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 FOLLOW-UP STUDY
|
Facility
|
IP
|
$12,192.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906820037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,438.40 |
| Max. Negotiated Rate |
$10,972.80 |
| Rate for Payer: Adventist Health Commercial |
$2,438.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,876.80
|
| Rate for Payer: Galaxy Health WC |
$10,363.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,132.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,645.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,546.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,438.40
|
| Rate for Payer: Multiplan Commercial |
$9,144.00
|
| Rate for Payer: Networks By Design Commercial |
$7,924.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,363.20
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
IP
|
$14,021.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906811304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,804.20 |
| Max. Negotiated Rate |
$12,618.90 |
| Rate for Payer: Adventist Health Commercial |
$2,804.20
|
| Rate for Payer: Cash Price |
$6,309.45
|
| Rate for Payer: Central Health Plan Commercial |
$11,216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,608.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,608.40
|
| Rate for Payer: Galaxy Health WC |
$11,917.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,412.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,618.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,342.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,679.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,804.20
|
| Rate for Payer: Multiplan Commercial |
$10,515.75
|
| Rate for Payer: Networks By Design Commercial |
$9,113.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,917.85
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$15,911.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906820048
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,182.20 |
| Max. Negotiated Rate |
$14,319.90 |
| Rate for Payer: Adventist Health Commercial |
$3,182.20
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: Central Health Plan Commercial |
$12,728.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,364.40
|
| Rate for Payer: Galaxy Health WC |
$13,524.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,319.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,612.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,062.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,848.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,182.20
|
| Rate for Payer: Multiplan Commercial |
$11,933.25
|
| Rate for Payer: Networks By Design Commercial |
$10,342.15
|
| Rate for Payer: Prime Health Services Commercial |
$13,524.35
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$18,298.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$16,468.20 |
| Rate for Payer: Adventist Health Commercial |
$3,659.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,553.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,063.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,723.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,859.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,746.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$8,234.10
|
| Rate for Payer: Cash Price |
$8,234.10
|
| Rate for Payer: Cash Price |
$8,234.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,638.40
|
| Rate for Payer: Cigna of CA HMO |
$11,710.72
|
| Rate for Payer: Cigna of CA PPO |
$13,540.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,553.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,553.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,553.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,319.20
|
| Rate for Payer: Galaxy Health WC |
$15,553.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,468.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$9,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,326.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,659.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,808.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,808.60
|
| Rate for Payer: Multiplan Commercial |
$13,723.50
|
| Rate for Payer: Networks By Design Commercial |
$11,893.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,553.30
|
| Rate for Payer: Riverside University Health System MISP |
$7,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,978.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,978.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,553.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,553.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15,553.30
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$18,298.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,659.60 |
| Max. Negotiated Rate |
$16,468.20 |
| Rate for Payer: Adventist Health Commercial |
$3,659.60
|
| Rate for Payer: Cash Price |
$8,234.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,638.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,319.20
|
| Rate for Payer: Galaxy Health WC |
$15,553.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,971.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,326.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,659.60
|
| Rate for Payer: Multiplan Commercial |
$13,723.50
|
| Rate for Payer: Networks By Design Commercial |
$11,893.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,553.30
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$15,911.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906820048
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$14,319.90 |
| Rate for Payer: Adventist Health Commercial |
$3,182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,524.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,751.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,933.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,704.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,344.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: Cash Price |
$7,159.95
|
| Rate for Payer: Central Health Plan Commercial |
$12,728.80
|
| Rate for Payer: Cigna of CA HMO |
$10,183.04
|
| Rate for Payer: Cigna of CA PPO |
$11,774.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,524.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,524.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,524.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,364.40
|
| Rate for Payer: Galaxy Health WC |
$13,524.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,319.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$7,955.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,612.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,848.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,182.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,137.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,137.70
|
| Rate for Payer: Multiplan Commercial |
$11,933.25
|
| Rate for Payer: Networks By Design Commercial |
$10,342.15
|
| Rate for Payer: Prime Health Services Commercial |
$13,524.35
|
| Rate for Payer: Riverside University Health System MISP |
$6,364.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,524.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,524.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,524.35
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$10,321.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,064.20 |
| Max. Negotiated Rate |
$9,288.90 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,256.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,128.40
|
| Rate for Payer: Galaxy Health WC |
$8,772.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,192.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,288.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,884.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,932.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,388.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,064.20
|
| Rate for Payer: Multiplan Commercial |
$7,740.75
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$11,869.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Adventist Health Commercial |
$2,373.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,088.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,527.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,901.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,746.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,970.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,341.05
|
| Rate for Payer: Cash Price |
$5,341.05
|
| Rate for Payer: Cash Price |
$5,341.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,495.20
|
| Rate for Payer: Cigna of CA HMO |
$7,596.16
|
| Rate for Payer: Cigna of CA PPO |
$8,783.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,088.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,088.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,088.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,747.60
|
| Rate for Payer: Galaxy Health WC |
$10,088.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,682.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$5,934.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,916.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,346.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,308.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,308.30
|
| Rate for Payer: Multiplan Commercial |
$8,901.75
|
| Rate for Payer: Networks By Design Commercial |
$7,714.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,088.65
|
| Rate for Payer: Riverside University Health System MISP |
$4,747.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,121.40
|
| 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 |
$10,088.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,088.65
|
| Rate for Payer: Vantage Medical Group Senior |
$10,088.65
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$11,869.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,373.80 |
| Max. Negotiated Rate |
$10,682.10 |
| Rate for Payer: Adventist Health Commercial |
$2,373.80
|
| Rate for Payer: Cash Price |
$5,341.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,747.60
|
| Rate for Payer: Galaxy Health WC |
$10,088.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,682.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,916.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,522.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,346.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.80
|
| Rate for Payer: Multiplan Commercial |
$8,901.75
|
| Rate for Payer: Networks By Design Commercial |
$7,714.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,088.65
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$10,321.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,676.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,740.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,997.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,061.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Cash Price |
$4,644.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,256.80
|
| Rate for Payer: Cigna of CA HMO |
$6,605.44
|
| Rate for Payer: Cigna of CA PPO |
$7,637.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,772.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,772.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,128.40
|
| Rate for Payer: Galaxy Health WC |
$8,772.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,192.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,288.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,202.86
|
| Rate for Payer: InnovAge PACE Commercial |
$5,160.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,884.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,328.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,388.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,064.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,224.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,224.70
|
| Rate for Payer: Multiplan Commercial |
$7,740.75
|
| Rate for Payer: Networks By Design Commercial |
$6,708.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,772.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,128.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,772.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,772.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,772.85
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,200.40 |
| Max. Negotiated Rate |
$9,901.80 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,801.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.40
|
| Rate for Payer: Multiplan Commercial |
$8,251.50
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,002.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,901.80 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,681.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,051.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,251.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,327.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,461.47
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,801.60
|
| Rate for Payer: Cigna of CA HMO |
$7,041.28
|
| Rate for Payer: Cigna of CA PPO |
$8,141.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,351.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,351.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,901.80
|
| Rate for Payer: InnovAge PACE Commercial |
$5,501.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,701.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,701.40
|
| Rate for Payer: Multiplan Commercial |
$8,251.50
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,400.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,351.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,351.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,351.70
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$9,352.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$8,416.80 |
| Rate for Payer: Adventist Health Commercial |
$1,870.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,679.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,949.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,143.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,014.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,528.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,492.43
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,208.40
|
| Rate for Payer: Cash Price |
$4,208.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,481.60
|
| Rate for Payer: Cigna of CA HMO |
$5,985.28
|
| Rate for Payer: Cigna of CA PPO |
$6,920.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,949.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,949.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,949.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,740.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,740.80
|
| Rate for Payer: Galaxy Health WC |
$7,949.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,611.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,416.80
|
| Rate for Payer: InnovAge PACE Commercial |
$4,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,237.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,788.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,870.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,546.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,546.40
|
| Rate for Payer: Multiplan Commercial |
$7,014.00
|
| Rate for Payer: Networks By Design Commercial |
$6,078.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,949.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,740.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,611.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,611.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,949.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,949.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,949.20
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$9,352.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,870.40 |
| Max. Negotiated Rate |
$8,416.80 |
| Rate for Payer: Adventist Health Commercial |
$1,870.40
|
| Rate for Payer: Cash Price |
$4,208.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,481.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,740.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,740.80
|
| Rate for Payer: Galaxy Health WC |
$7,949.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,611.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,416.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,237.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,563.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,788.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,870.40
|
| Rate for Payer: Multiplan Commercial |
$7,014.00
|
| Rate for Payer: Networks By Design Commercial |
$6,078.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,949.20
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$7,039.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,407.80 |
| Max. Negotiated Rate |
$6,335.10 |
| Rate for Payer: Adventist Health Commercial |
$1,407.80
|
| Rate for Payer: Cash Price |
$3,167.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,631.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,815.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,815.60
|
| Rate for Payer: Galaxy Health WC |
$5,983.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,223.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,335.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,695.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,681.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,357.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.80
|
| Rate for Payer: Multiplan Commercial |
$5,279.25
|
| Rate for Payer: Networks By Design Commercial |
$4,575.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,983.15
|
|
|
HC EPS RV RECORDING
|
Facility
|
IP
|
$5,983.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906811321
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,196.60 |
| Max. Negotiated Rate |
$5,384.70 |
| Rate for Payer: Adventist Health Commercial |
$1,196.60
|
| Rate for Payer: Cash Price |
$2,692.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,786.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,393.20
|
| Rate for Payer: Galaxy Health WC |
$5,085.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,384.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,990.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,279.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,703.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.60
|
| Rate for Payer: Multiplan Commercial |
$4,487.25
|
| Rate for Payer: Networks By Design Commercial |
$3,888.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,085.55
|
|
