|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,698.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,320.30
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,728.00
|
| Rate for Payer: Cigna of CA PPO |
$1,998.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,620.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
|
|
HC EPIFIX 2X3
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.02
|
| Rate for Payer: Blue Distinction Transplant |
$390.00
|
| Rate for Payer: Blue Shield of California Commercial |
$408.85
|
| Rate for Payer: Blue Shield of California EPN |
$317.85
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$455.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$552.50
|
| Rate for Payer: Dignity Health Media |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$487.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: Riverside University Health System MISP |
$260.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO |
$325.00
|
| Rate for Payer: United Healthcare HMO Rider |
$325.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
HC EPIFIX 2X3
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Blue Shield of California Commercial |
$487.50
|
| Rate for Payer: Blue Shield of California EPN |
$347.10
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$455.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.44
|
| Rate for Payer: United Healthcare All Other HMO |
$239.72
|
| Rate for Payer: United Healthcare HMO Rider |
$234.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.50
|
|
|
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 |
$432.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.11
|
| 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 |
$264.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.17
|
| Rate for Payer: Blue Distinction Transplant |
$288.60
|
| Rate for Payer: Blue Shield of California Commercial |
$302.55
|
| Rate for Payer: Blue Shield of California EPN |
$235.21
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| 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 Media |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$360.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Riverside University Health System MISP |
$192.40
|
| 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 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 |
$432.90 |
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| 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 |
$376.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$253.85
|
| 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 |
$229.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.95
|
| Rate for Payer: Blue Distinction Transplant |
$250.80
|
| Rate for Payer: Blue Shield of California Commercial |
$262.92
|
| Rate for Payer: Blue Shield of California EPN |
$204.40
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| 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 Media |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$313.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Riverside University Health System MISP |
$167.20
|
| 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 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 |
$376.20 |
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| 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
|
IP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,878.20 |
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Health Management Network EPO/PPO |
$2,878.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,133.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.60
|
| Rate for Payer: Multiplan Commercial |
$2,398.50
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
|
|
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 |
$6,862.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,862.04
|
| 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 |
$1,758.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,548.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,889.38
|
| Rate for Payer: Blue Distinction Transplant |
$1,918.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,011.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,563.82
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,558.40
|
| 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 Media |
$2,718.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,718.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Management Network EPO/PPO |
$2,878.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,398.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,119.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,133.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.60
|
| Rate for Payer: Multiplan Commercial |
$2,398.50
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,279.20
|
| 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 Medi-Cal |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,718.30
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,072.80 |
| Max. Negotiated Rate |
$9,327.60 |
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,327.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.80
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$593.83 |
| Max. Negotiated Rate |
$9,327.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$629.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,700.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,700.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,218.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,291.20
|
| Rate for Payer: Cigna of CA HMO |
$6,632.96
|
| Rate for Payer: Cigna of CA PPO |
$7,669.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Dignity Health Media |
$8,809.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,809.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,327.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,773.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,627.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.80
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,145.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,218.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,809.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,809.40
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,072.80 |
| Max. Negotiated Rate |
$9,327.60 |
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,327.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.80
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$593.83 |
| Max. Negotiated Rate |
$9,327.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$629.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,700.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,700.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,218.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,291.20
|
| Rate for Payer: Cigna of CA HMO |
$6,632.96
|
| Rate for Payer: Cigna of CA PPO |
$7,669.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Dignity Health Media |
$8,809.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,809.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,145.60
|
| Rate for Payer: Galaxy Health WC |
$8,809.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,218.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,327.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,773.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,627.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.80
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
| Rate for Payer: Networks By Design Commercial |
$6,736.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,809.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,145.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,218.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,809.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,809.40
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,232.80 |
| Max. Negotiated Rate |
$5,547.60 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$336.15 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,486.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,486.99
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,453.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2,230.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,992.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,576.21
|
| Rate for Payer: Riverside University Health System MISP |
$1,635.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$336.15 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,486.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,486.99
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,453.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2,230.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,992.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,576.21
|
| Rate for Payer: Riverside University Health System MISP |
$1,635.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,232.80 |
| Max. Negotiated Rate |
$5,547.60 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ARTERIAL CATH SET
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
906811777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.15
|
| Rate for Payer: Blue Distinction Transplant |
$172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$181.15
|
| Rate for Payer: Blue Shield of California EPN |
$140.83
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Media |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC EPS ARTERIAL CATH SET
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
906811777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,232.80 |
| Max. Negotiated Rate |
$5,547.60 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$201.17 |
| Max. Negotiated Rate |
$15,396.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,331.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,331.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$9,331.00
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Media |
$9,331.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,596.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,331.00
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,302.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,396.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: InnovAge PACE Commercial |
$13,996.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,503.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,503.54
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Prime Health Services Medicare |
$9,890.86
|
| Rate for Payer: Riverside University Health System MISP |
$10,264.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,331.00
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,232.80 |
| Max. Negotiated Rate |
$5,547.60 |
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,465.60
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$201.17 |
| Max. Negotiated Rate |
$15,396.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,331.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,331.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$9,331.00
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,931.20
|
| Rate for Payer: Cigna of CA HMO |
$3,944.96
|
| Rate for Payer: Cigna of CA PPO |
$4,561.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Media |
$9,331.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,596.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,331.00
|
| Rate for Payer: Galaxy Health WC |
$5,239.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,547.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,302.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,396.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: InnovAge PACE Commercial |
$13,996.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,503.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,503.54
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: Networks By Design Commercial |
$4,006.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,239.40
|
| Rate for Payer: Prime Health Services Medicare |
$9,890.86
|
| Rate for Payer: Riverside University Health System MISP |
$10,264.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,331.00
|
|
