|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.98
|
| 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 |
$127.92
|
| 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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
IP
|
$6,440.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906811326
|
|
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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
IP
|
$6,440.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906811327
|
|
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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
OP
|
$6,440.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906811327
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.88
|
| 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 |
$145.83
|
| 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 |
$1,635.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1,486.99
|
| 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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906820046
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.88
|
| 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 |
$145.83
|
| 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 |
$1,635.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1,486.99
|
| 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 ESOPHOGEAL ATRIAL REC/PAC
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
CPT 93616
|
| Hospital Charge Code |
906820046
|
|
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 FOLLOW-UP STUDY
|
Facility
|
OP
|
$10,602.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906820037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$186.92 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$2,120.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,283.57
|
| 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 |
$8,054.00
|
| 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 |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,891.30
|
| 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 |
$6,562.64
|
| 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 |
$445.57
|
| 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 |
$1,918.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.50
|
| 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 |
$7,951.50
|
| 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 FOLLOW-UP STUDY
|
Facility
|
OP
|
$10,602.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906811304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$186.92 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$2,120.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,283.57
|
| 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 |
$8,054.00
|
| 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 |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,891.30
|
| 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 |
$6,562.64
|
| 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 |
$445.57
|
| 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 |
$1,918.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.50
|
| 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 |
$7,951.50
|
| 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 FOLLOW-UP STUDY
|
Facility
|
IP
|
$10,602.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906820037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,918.96 |
| Max. Negotiated Rate |
$7,951.50 |
| Rate for Payer: Adventist Health Commercial |
$2,120.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,283.57
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| 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 |
$1,918.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.50
|
| Rate for Payer: Multiplan Commercial |
$7,951.50
|
|
|
HC EPS FOLLOW-UP STUDY
|
Facility
|
IP
|
$10,602.00
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
906811304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,918.96 |
| Max. Negotiated Rate |
$7,951.50 |
| Rate for Payer: Adventist Health Commercial |
$2,120.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,283.57
|
| Rate for Payer: Cash Price |
$4,770.90
|
| Rate for Payer: Cash Price |
$4,770.90
|
| 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 |
$1,918.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.50
|
| Rate for Payer: Multiplan Commercial |
$7,951.50
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$13,836.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$11,760.60 |
| Rate for Payer: Adventist Health Commercial |
$2,767.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,505.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,760.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,609.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,377.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,993.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,760.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,760.60
|
| Rate for Payer: Dignity Health Senior |
$11,760.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,993.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,564.48
|
| Rate for Payer: Heritage Provider Network Senior |
$8,564.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,090.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,668.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,504.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,459.00
|
| Rate for Payer: Multiplan Commercial |
$10,377.00
|
| 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 |
$11,760.60
|
| Rate for Payer: Vantage Medical Group Senior |
$11,760.60
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
OP
|
$13,836.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906820048
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$11,760.60 |
| Rate for Payer: Adventist Health Commercial |
$2,767.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,505.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,760.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,609.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,377.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,993.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,760.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,760.60
|
| Rate for Payer: Dignity Health Senior |
$11,760.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,993.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,564.48
|
| Rate for Payer: Heritage Provider Network Senior |
$8,564.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,090.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,668.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,504.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,459.00
|
| Rate for Payer: Multiplan Commercial |
$10,377.00
|
| 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 |
$11,760.60
|
| Rate for Payer: Vantage Medical Group Senior |
$11,760.60
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$13,836.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906811329
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,504.32 |
| Max. Negotiated Rate |
$10,377.00 |
| Rate for Payer: Adventist Health Commercial |
$2,767.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,505.33
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| 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 |
$2,504.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,459.00
|
| Rate for Payer: Multiplan Commercial |
$10,377.00
|
|
|
HC EPS LA/CS PACING & RECORDING
|
Facility
|
IP
|
$13,836.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
906820048
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,504.32 |
| Max. Negotiated Rate |
$10,377.00 |
| Rate for Payer: Adventist Health Commercial |
$2,767.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,505.33
|
| Rate for Payer: Cash Price |
$6,226.20
|
| Rate for Payer: Cash Price |
$6,226.20
|
| 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 |
$2,504.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,459.00
|
| Rate for Payer: Multiplan Commercial |
$10,377.00
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$8,975.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,624.48 |
| Max. Negotiated Rate |
$6,731.25 |
| Rate for Payer: Adventist Health Commercial |
$1,795.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,165.82
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| 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 |
$1,624.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.75
|
| Rate for Payer: Multiplan Commercial |
$6,731.25
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$8,975.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,795.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,165.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,628.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,936.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,731.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,833.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,628.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,628.75
|
| Rate for Payer: Dignity Health Senior |
$7,628.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,833.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,555.52
|
| Rate for Payer: Heritage Provider Network Senior |
$5,555.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,090.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,325.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,624.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.75
|
| Rate for Payer: Multiplan Commercial |
$6,731.25
|
| 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 |
$7,628.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,628.75
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
IP
|
$8,975.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906811330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,624.48 |
| Max. Negotiated Rate |
$6,731.25 |
| Rate for Payer: Adventist Health Commercial |
$1,795.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,165.82
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| 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 |
$1,624.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.75
|
| Rate for Payer: Multiplan Commercial |
$6,731.25
|
|
|
HC EPS LV PACING & RECORDING
|
Facility
|
OP
|
$8,975.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
906820049
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,795.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,165.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,628.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,936.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,731.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cash Price |
$4,038.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,833.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,628.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,628.75
|
| Rate for Payer: Dignity Health Senior |
$7,628.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,833.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,555.52
|
| Rate for Payer: Heritage Provider Network Senior |
$5,555.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,090.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,325.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,624.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.75
|
| Rate for Payer: Multiplan Commercial |
$6,731.25
|
| 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 |
$7,628.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,628.75
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$11,581.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,096.16 |
| Max. Negotiated Rate |
$8,685.75 |
| Rate for Payer: Adventist Health Commercial |
$2,316.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,956.15
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| 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 |
$2,096.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,895.25
|
| Rate for Payer: Multiplan Commercial |
$8,685.75
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$6,452.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$130.35 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,290.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,432.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,484.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,548.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,839.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,193.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,484.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,484.20
|
| Rate for Payer: Dignity Health Senior |
$5,484.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,193.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,993.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,993.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,109.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.00
|
| Rate for Payer: Multiplan Commercial |
$4,839.00
|
| 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 |
$5,484.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,484.20
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
OP
|
$11,581.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906820050
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$130.35 |
| Max. Negotiated Rate |
$9,843.85 |
| Rate for Payer: Adventist Health Commercial |
$2,316.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,956.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,843.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,369.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,685.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cash Price |
$5,211.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,527.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,843.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,843.85
|
| Rate for Payer: Dignity Health Senior |
$9,843.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,527.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,168.64
|
| Rate for Payer: Heritage Provider Network Senior |
$7,168.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,582.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,096.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,895.25
|
| Rate for Payer: Multiplan Commercial |
$8,685.75
|
| 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 |
$9,843.85
|
| Rate for Payer: Vantage Medical Group Senior |
$9,843.85
|
|
|
HC EPS POST DRUG INFUSION
|
Facility
|
IP
|
$6,452.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
906811331
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,167.81 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,290.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,432.52
|
| Rate for Payer: Cash Price |
$2,903.40
|
| Rate for Payer: Cash Price |
$2,903.40
|
| 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 |
$1,167.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,613.00
|
| Rate for Payer: Multiplan Commercial |
$4,839.00
|
|
|
HC EPS RV RECORDING
|
Facility
|
OP
|
$7,409.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.49 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,481.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,089.98
|
| 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 |
$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 |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,815.85
|
| 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 |
$4,586.17
|
| 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 |
$248.52
|
| 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 |
$1,341.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,852.25
|
| 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 |
$5,556.75
|
| 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 RV RECORDING
|
Facility
|
IP
|
$7,409.00
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
906820041
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,341.03 |
| Max. Negotiated Rate |
$5,556.75 |
| Rate for Payer: Adventist Health Commercial |
$1,481.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,089.98
|
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: Cash Price |
$3,334.05
|
| 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 |
$1,341.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,852.25
|
| Rate for Payer: Multiplan Commercial |
$5,556.75
|
|
