|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$914.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$689.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$634.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
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: Cash Price |
$417.45
|
| 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 |
$351.42
|
| Rate for Payer: Heritage Provider Network Senior |
$351.42
|
| 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 |
$274.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.30
|
|
|
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 |
$405.69
|
| 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 |
$462.99
|
| Rate for Payer: Blue Shield of California EPN |
$370.39
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: Cash Price |
$417.45
|
| 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 |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$362.04
|
| 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: Molina Healthcare of CA Medi-Cal |
$531.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.30
|
| 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 |
$274.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$9,846.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,969.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,262.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,764.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,369.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,415.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,384.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,415.30
|
| Rate for Payer: Cash Price |
$5,415.30
|
| Rate for Payer: Cash Price |
$5,415.30
|
| Rate for Payer: Cash Price |
$5,415.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,399.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,369.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,369.10
|
| Rate for Payer: Dignity Health Senior |
$8,369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,399.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,094.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6,094.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,696.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,782.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,461.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,892.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,892.20
|
| Rate for Payer: Multiplan Commercial |
$7,384.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,369.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,369.10
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$9,846.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,782.13 |
| Max. Negotiated Rate |
$7,384.50 |
| Rate for Payer: Adventist Health Commercial |
$1,969.20
|
| Rate for Payer: Cash Price |
$5,415.30
|
| Rate for Payer: Cash Price |
$5,415.30
|
| 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 |
$1,782.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,461.50
|
| Rate for Payer: Multiplan Commercial |
$7,384.50
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$6,159.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,231.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,291.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,231.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,235.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,387.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,619.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,387.45
|
| Rate for Payer: Cash Price |
$3,387.45
|
| Rate for Payer: Cash Price |
$3,387.45
|
| Rate for Payer: Cash Price |
$3,387.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,003.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,235.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,235.15
|
| Rate for Payer: Dignity Health Senior |
$5,235.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,003.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,812.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,812.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,937.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,311.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,311.30
|
| Rate for Payer: Multiplan Commercial |
$4,619.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,235.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,235.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,235.15
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$6,159.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,114.78 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,231.80
|
| Rate for Payer: Cash Price |
$3,387.45
|
| Rate for Payer: Cash Price |
$3,387.45
|
| 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 |
$1,114.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.75
|
| Rate for Payer: Multiplan Commercial |
$4,619.25
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$901.02 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| 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 |
$901.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,023.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,806.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Senior |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,542.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,624.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,897.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,930.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,059.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,773.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,943.55
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,419.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,235.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Senior |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,542.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,081.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,897.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,930.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$901.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,773.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,943.55
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906820047
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,059.94 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| 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 |
$1,059.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.00
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,059.94 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| 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 |
$1,059.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.00
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,660.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,419.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,235.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,081.38
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$901.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906811324
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$901.02 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| 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 |
$901.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
|
|
HC EPS ATRIAL PACING
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
906820043
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,130.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,023.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,806.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,624.86
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,059.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906811320
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,660.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,419.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,235.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,081.38
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$901.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906820040
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,130.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,023.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,806.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,624.86
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,059.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906820040
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,059.94 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,171.20
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| 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 |
$1,059.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,464.00
|
| Rate for Payer: Multiplan Commercial |
$4,392.00
|
|
|
HC EPS ATRIAL RECORDING
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
906811320
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$901.02 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Cash Price |
$2,737.90
|
| Rate for Payer: Cash Price |
$2,737.90
|
| 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 |
$901.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
|
|
HC EPS BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$8,063.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906820038
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,459.40 |
| Max. Negotiated Rate |
$6,047.25 |
| Rate for Payer: Adventist Health Commercial |
$1,612.60
|
| Rate for Payer: Cash Price |
$4,434.65
|
| Rate for Payer: Cash Price |
$4,434.65
|
| 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 |
$1,459.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,015.75
|
| Rate for Payer: Multiplan Commercial |
$6,047.25
|
|
|
HC EPS BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$8,063.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906820038
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,612.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,539.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,434.65
|
| Rate for Payer: Cash Price |
$4,434.65
|
| Rate for Payer: Cash Price |
$4,434.65
|
| Rate for Payer: Cash Price |
$4,434.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,240.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,991.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,459.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,015.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$6,047.25
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$6,606.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906811305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,321.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,538.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,293.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Senior |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,641.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,089.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,318.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,195.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,148.21
|
| Rate for Payer: Multiplan Commercial |
$4,954.50
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$6,606.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
906811305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,195.69 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,321.20
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| 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 |
$1,195.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.50
|
| Rate for Payer: Multiplan Commercial |
$4,954.50
|
|
|
HC EPS CATH ABLATION OF AV NODE
|
Facility
|
IP
|
$8,841.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
906811334
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,600.22 |
| Max. Negotiated Rate |
$6,630.75 |
| Rate for Payer: Adventist Health Commercial |
$1,768.20
|
| Rate for Payer: Cash Price |
$4,862.55
|
| Rate for Payer: Cash Price |
$4,862.55
|
| 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 |
$1,600.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.25
|
| Rate for Payer: Multiplan Commercial |
$6,630.75
|
|
|
HC EPS CATH ABLATION OF AV NODE
|
Facility
|
IP
|
$10,401.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
906820052
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,882.58 |
| Max. Negotiated Rate |
$7,800.75 |
| Rate for Payer: Adventist Health Commercial |
$2,080.20
|
| Rate for Payer: Cash Price |
$5,720.55
|
| Rate for Payer: Cash Price |
$5,720.55
|
| 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 |
$1,882.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,600.25
|
| Rate for Payer: Multiplan Commercial |
$7,800.75
|
|
