|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,089.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.18
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.34
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$864.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIFIX 2X3
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$372.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Blue Shield of California Commercial |
$471.34
|
| Rate for Payer: Blue Shield of California EPN |
$445.53
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.15
|
| Rate for Payer: Dignity Health Senior |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.42
|
| Rate for Payer: Heritage Provider Network Senior |
$351.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$365.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC EPIFIX 2X3
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$569.25 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.84
|
| Rate for Payer: Heritage Provider Network Senior |
$513.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.58
|
|
|
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 |
$249.58 |
| Max. Negotiated Rate |
$8,809.40 |
| Rate for Payer: Adventist Health Commercial |
$2,072.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$249.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,120.07
|
| 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 |
$7,773.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cash Price |
$4,663.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,736.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,809.40
|
| Rate for Payer: Dignity Health Senior |
$8,809.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,736.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,415.32
|
| Rate for Payer: Heritage Provider Network Senior |
$6,415.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$487.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,995.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,875.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.00
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
OP
|
$7,217.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$249.58 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$249.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,958.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,969.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,412.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,691.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,134.45
|
| Rate for Payer: Dignity Health Senior |
$6,134.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,691.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,467.32
|
| Rate for Payer: Heritage Provider Network Senior |
$4,467.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$487.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,478.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.25
|
| Rate for Payer: Multiplan Commercial |
$5,412.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,134.45
|
|
|
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 |
$1,875.88 |
| Max. Negotiated Rate |
$7,773.00 |
| Rate for Payer: Adventist Health Commercial |
$2,072.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,120.07
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,875.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.00
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$7,217.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,306.28 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,958.08
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.25
|
| Rate for Payer: Multiplan Commercial |
$5,412.75
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,234.67
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cash Price |
$2,773.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,006.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,815.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,829.00
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$276.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,200.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,200.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 |
$1,115.68 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,234.67
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.00
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$6,440.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,165.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$6,440.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,186.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,986.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,829.00
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$276.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,200.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,200.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 ATRIAL PACING
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,115.68 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,234.67
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.00
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$6,440.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,165.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$6,440.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,186.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,986.36
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,234.67
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cash Price |
$2,773.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,006.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,815.52
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 RECORDING
|
Facility
|
IP
|
$6,440.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906811320
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,165.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906820040
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,115.68 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,234.67
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Cash Price |
$2,773.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.00
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
OP
|
$6,440.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906811320
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$111.91 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,186.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,986.36
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 RECORDING
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906820040
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$111.91 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,234.67
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cash Price |
$2,773.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,006.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,815.52
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,541.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$4,623.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$7,740.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906811305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$254.98 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,548.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,317.38
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,031.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,791.06
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$5,805.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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 BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$7,740.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906811305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,400.94 |
| Max. Negotiated Rate |
$5,805.00 |
| Rate for Payer: Adventist Health Commercial |
$1,548.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,317.38
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,935.00
|
| Rate for Payer: Multiplan Commercial |
$5,805.00
|
|
|
HC EPS BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$8,487.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906820038
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,536.15 |
| Max. Negotiated Rate |
$6,365.25 |
| Rate for Payer: Adventist Health Commercial |
$1,697.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,830.57
|
| Rate for Payer: Cash Price |
$3,819.15
|
| Rate for Payer: Cash Price |
$3,819.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,536.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,121.75
|
| Rate for Payer: Multiplan Commercial |
$6,365.25
|
|
|
HC EPS BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$8,487.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906820038
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$254.98 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$1,697.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,830.57
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,819.15
|
| Rate for Payer: Cash Price |
$3,819.15
|
| Rate for Payer: Cash Price |
$3,819.15
|
| Rate for Payer: Cash Price |
$3,819.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,516.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,264.10
|
| Rate for Payer: Dignity Health Senior |
$9,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,253.45
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,728.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,536.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$6,365.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
|
