|
HC EPS CATH ABLATION OF AV NODE
|
Facility
|
OP
|
$8,841.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
906811334
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$1,768.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,073.77
|
| 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 |
$14,720.00
|
| 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 |
$4,862.55
|
| Rate for Payer: Cash Price |
$4,862.55
|
| Rate for Payer: Cash Price |
$4,862.55
|
| Rate for Payer: Cash Price |
$4,862.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,746.65
|
| 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 |
$5,472.58
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.45
|
| 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 |
$1,600.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.25
|
| 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 |
$6,630.75
|
| 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 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 COMP W ARRHYTHMIA INDUCT
|
Facility
|
OP
|
$27,018.00
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
906820036
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$20,263.50 |
| Rate for Payer: Adventist Health Commercial |
$5,403.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,561.37
|
| 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 |
$8,785.00
|
| 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 |
$14,859.90
|
| Rate for Payer: Cash Price |
$14,859.90
|
| Rate for Payer: Cash Price |
$14,859.90
|
| Rate for Payer: Cash Price |
$14,859.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,561.70
|
| 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 |
$16,724.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,132.93
|
| 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 |
$4,890.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,754.50
|
| 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 |
$20,263.50
|
| 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 COMP W ARRHYTHMIA INDUCT
|
Facility
|
OP
|
$22,965.00
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
906811303
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$4,593.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,776.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| 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 |
$12,630.75
|
| Rate for Payer: Cash Price |
$12,630.75
|
| Rate for Payer: Cash Price |
$12,630.75
|
| Rate for Payer: Cash Price |
$12,630.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,927.25
|
| 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 |
$14,215.33
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,132.93
|
| 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 |
$4,156.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,741.25
|
| 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 |
$17,223.75
|
| 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 COMP W ARRHYTHMIA INDUCT
|
Facility
|
IP
|
$27,018.00
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
906820036
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,890.26 |
| Max. Negotiated Rate |
$20,263.50 |
| Rate for Payer: Adventist Health Commercial |
$5,403.60
|
| Rate for Payer: Cash Price |
$14,859.90
|
| Rate for Payer: Cash Price |
$14,859.90
|
| 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 |
$4,890.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,754.50
|
| Rate for Payer: Multiplan Commercial |
$20,263.50
|
|
|
HC EPS COMP W ARRHYTHMIA INDUCT
|
Facility
|
IP
|
$22,965.00
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
906811303
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,156.66 |
| Max. Negotiated Rate |
$17,223.75 |
| Rate for Payer: Adventist Health Commercial |
$4,593.00
|
| Rate for Payer: Cash Price |
$12,630.75
|
| Rate for Payer: Cash Price |
$12,630.75
|
| 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 |
$4,156.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,741.25
|
| Rate for Payer: Multiplan Commercial |
$17,223.75
|
|
|
HC EPS COMP W/O ARRHYTHMIA INDUCT
|
Facility
|
OP
|
$19,204.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906820053
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$3,840.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,193.15
|
| 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 |
$8,785.00
|
| 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 |
$10,562.20
|
| Rate for Payer: Cash Price |
$10,562.20
|
| Rate for Payer: Cash Price |
$10,562.20
|
| Rate for Payer: Cash Price |
$10,562.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,482.60
|
| 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 |
$11,887.28
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$966.27
|
| 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 |
$3,475.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,801.00
|
| 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 |
$14,403.00
|
| 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 COMP W/O ARRHYTHMIA INDUCT
|
Facility
|
IP
|
$19,204.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906820053
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,475.92 |
| Max. Negotiated Rate |
$14,403.00 |
| Rate for Payer: Adventist Health Commercial |
$3,840.80
|
| Rate for Payer: Cash Price |
$10,562.20
|
| Rate for Payer: Cash Price |
$10,562.20
|
| 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 |
$3,475.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,801.00
|
| Rate for Payer: Multiplan Commercial |
$14,403.00
|
|
|
HC EPS COMP W/O ARRHYTHMIA INDUCT
|
Facility
|
IP
|
$16,323.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906811349
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,954.46 |
| Max. Negotiated Rate |
$12,242.25 |
| Rate for Payer: Adventist Health Commercial |
$3,264.60
|
| Rate for Payer: Cash Price |
$8,977.65
|
| Rate for Payer: Cash Price |
$8,977.65
|
| 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 |
$2,954.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,080.75
|
| Rate for Payer: Multiplan Commercial |
$12,242.25
|
|
|
HC EPS COMP W/O ARRHYTHMIA INDUCT
|
Facility
|
OP
|
$16,323.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906811349
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,318.74 |
| Rate for Payer: Adventist Health Commercial |
$3,264.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,213.90
|
| 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 |
$8,785.00
|
| 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 |
$8,977.65
|
| Rate for Payer: Cash Price |
$8,977.65
|
| Rate for Payer: Cash Price |
$8,977.65
|
| Rate for Payer: Cash Price |
$8,977.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,609.95
|
| 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 |
$10,103.94
|
| Rate for Payer: Heritage Provider Network Senior |
$11,858.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$966.27
|
| 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 |
$2,954.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,087.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,080.75
|
| 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 |
$12,242.25
|
| 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 COMP W PULM VEIN AFIB ABL
|
Facility
|
OP
|
$55,683.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906820251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$59,224.41 |
| Rate for Payer: Adventist Health Commercial |
$11,136.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,254.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$30,625.65
|
| Rate for Payer: Cash Price |
$30,625.65
|
| Rate for Payer: Cash Price |
$30,625.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Senior |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$31,170.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$34,467.78
|
| Rate for Payer: Heritage Provider Network Senior |
$38,340.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,426.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,224.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,078.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,846.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,920.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,275.13
|
| Rate for Payer: Multiplan Commercial |
$41,762.25
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
|
IP
|
$55,683.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906820251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,571.00 |
| Max. Negotiated Rate |
$41,762.25 |
| Rate for Payer: Adventist Health Commercial |
$11,136.60
|
| Rate for Payer: Cash Price |
$30,625.65
|
| Rate for Payer: Cash Price |
$30,625.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,325.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,078.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,920.75
|
| Rate for Payer: Multiplan Commercial |
$41,762.25
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
|
OP
|
$28,896.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906811448
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$59,224.41 |
| Rate for Payer: Adventist Health Commercial |
$5,779.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,851.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Senior |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$31,170.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,886.62
|
| Rate for Payer: Heritage Provider Network Senior |
$38,340.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,426.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,224.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,230.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,846.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,275.13
|
| Rate for Payer: Multiplan Commercial |
$21,672.00
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
|
IP
|
$28,896.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906811448
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,230.18 |
| Max. Negotiated Rate |
$21,672.00 |
| Rate for Payer: Adventist Health Commercial |
$5,779.20
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,325.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,230.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,224.00
|
| Rate for Payer: Multiplan Commercial |
$21,672.00
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
IP
|
$39,253.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906820248
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$29,439.75 |
| Rate for Payer: Adventist Health Commercial |
$7,850.60
|
| Rate for Payer: Cash Price |
$21,589.15
|
| Rate for Payer: Cash Price |
$21,589.15
|
| 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 |
$7,104.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,813.25
|
| Rate for Payer: Multiplan Commercial |
$29,439.75
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
IP
|
$28,896.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906811445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$21,672.00 |
| Rate for Payer: Adventist Health Commercial |
$5,779.20
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| 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 |
$5,230.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,224.00
|
| Rate for Payer: Multiplan Commercial |
$21,672.00
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
OP
|
$39,253.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906820248
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$59,224.41 |
| Rate for Payer: Adventist Health Commercial |
$7,850.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,966.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$21,589.15
|
| Rate for Payer: Cash Price |
$21,589.15
|
| Rate for Payer: Cash Price |
$21,589.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Senior |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$31,170.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,297.61
|
| Rate for Payer: Heritage Provider Network Senior |
$38,340.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,068.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,224.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,104.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,846.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,813.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,275.13
|
| Rate for Payer: Multiplan Commercial |
$29,439.75
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
|
OP
|
$28,896.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906811445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$59,224.41 |
| Rate for Payer: Adventist Health Commercial |
$5,779.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,851.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Senior |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$31,170.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,886.62
|
| Rate for Payer: Heritage Provider Network Senior |
$38,340.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,068.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,224.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,230.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,846.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,275.13
|
| Rate for Payer: Multiplan Commercial |
$21,672.00
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
IP
|
$36,546.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906820249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,409.50 |
| Rate for Payer: Adventist Health Commercial |
$7,309.20
|
| Rate for Payer: Cash Price |
$20,100.30
|
| Rate for Payer: Cash Price |
$20,100.30
|
| 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 |
$6,614.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,136.50
|
| Rate for Payer: Multiplan Commercial |
$27,409.50
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
OP
|
$28,896.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906811446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$59,224.41 |
| Rate for Payer: Adventist Health Commercial |
$5,779.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,851.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Senior |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$31,170.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,886.62
|
| Rate for Payer: Heritage Provider Network Senior |
$38,340.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,425.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,224.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,230.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,846.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,275.13
|
| Rate for Payer: Multiplan Commercial |
$21,672.00
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
OP
|
$36,546.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906820249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$59,224.41 |
| Rate for Payer: Adventist Health Commercial |
$7,309.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,107.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,170.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$20,100.30
|
| Rate for Payer: Cash Price |
$20,100.30
|
| Rate for Payer: Cash Price |
$20,100.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,287.81
|
| Rate for Payer: Dignity Health Senior |
$31,170.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$31,170.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,621.97
|
| Rate for Payer: Heritage Provider Network Senior |
$38,340.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,425.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,170.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,224.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,614.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,846.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,136.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,275.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,275.13
|
| Rate for Payer: Multiplan Commercial |
$27,409.50
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,756.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,287.81
|
| Rate for Payer: Vantage Medical Group Senior |
$31,170.74
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
|
IP
|
$28,896.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906811446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$21,672.00 |
| Rate for Payer: Adventist Health Commercial |
$5,779.20
|
| Rate for Payer: Cash Price |
$15,892.80
|
| Rate for Payer: Cash Price |
$15,892.80
|
| 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 |
$5,230.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,224.00
|
| Rate for Payer: Multiplan Commercial |
$21,672.00
|
|
|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906811326
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$132.84 |
| Max. Negotiated Rate |
$8,962.13 |
| 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 |
$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 |
$132.84
|
| 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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
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 ESOPHOGEAL ATRIAL RECORD
|
Facility
|
OP
|
$5,856.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906820045
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$132.84 |
| Max. Negotiated Rate |
$8,962.13 |
| 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 |
$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 |
$132.84
|
| 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
|
|
