|
HC EPS COMP W/O ARRHYTHMIA INDUCT
|
Facility
OP
|
$16,699.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906811349
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$3,339.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,472.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: AlphaCare 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 |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,854.35
|
| 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 |
$10,336.68
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: IEHP Medi-Cal |
$930.48
|
| Rate for Payer: 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 |
$3,022.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,174.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$12,524.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,331.00
|
|
|
HC EPS COMP W/O ARRHYTHMIA INDUCT
|
Facility
IP
|
$16,699.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906820053
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,022.52 |
| Max. Negotiated Rate |
$12,524.25 |
| Rate for Payer: Adventist Health Commercial |
$3,339.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,472.21
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| 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 |
$3,022.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,174.75
|
| Rate for Payer: Multiplan Commercial |
$12,524.25
|
|
|
HC EPS COMP W/O ARRHYTHMIA INDUCT
|
Facility
OP
|
$16,699.00
|
|
|
Service Code
|
CPT 93619
|
| Hospital Charge Code |
906820053
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$17,728.90 |
| Rate for Payer: Adventist Health Commercial |
$3,339.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,472.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: AlphaCare 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 |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cash Price |
$7,514.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,854.35
|
| 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 |
$10,336.68
|
| Rate for Payer: Heritage Provider Network Senior |
$11,477.13
|
| Rate for Payer: Humana Medicare |
$9,331.00
|
| Rate for Payer: IEHP Medi-Cal |
$930.48
|
| Rate for Payer: 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 |
$3,022.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,010.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,174.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,757.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,757.06
|
| Rate for Payer: Multiplan Commercial |
$12,524.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,600.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,331.00
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
OP
|
$33,857.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906811448
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,373.53 |
| Max. Negotiated Rate |
$56,381.66 |
| Rate for Payer: Adventist Health Commercial |
$6,771.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,259.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,674.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,642.02
|
| Rate for Payer: Dignity Health Senior |
$29,674.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,674.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,957.48
|
| Rate for Payer: Heritage Provider Network Senior |
$36,499.71
|
| Rate for Payer: Humana Medicare |
$29,674.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,373.53
|
| Rate for Payer: IEHP Medicare Advantage |
$29,674.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56,381.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,128.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,464.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,389.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,389.95
|
| Rate for Payer: Multiplan Commercial |
$25,392.75
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,674.56
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
IP
|
$33,857.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906811448
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,478.00 |
| Max. Negotiated Rate |
$25,392.75 |
| Rate for Payer: Adventist Health Commercial |
$6,771.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,259.76
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,464.25
|
| Rate for Payer: Multiplan Commercial |
$25,392.75
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
IP
|
$58,614.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906820251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,478.00 |
| Max. Negotiated Rate |
$43,960.50 |
| Rate for Payer: Adventist Health Commercial |
$11,722.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,267.82
|
| Rate for Payer: Cash Price |
$26,376.30
|
| Rate for Payer: Cash Price |
$26,376.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,609.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,653.50
|
| Rate for Payer: Multiplan Commercial |
$43,960.50
|
|
|
HC EPS COMP W PULM VEIN AFIB ABL
|
Facility
OP
|
$58,614.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
906820251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,373.53 |
| Max. Negotiated Rate |
$56,381.66 |
| Rate for Payer: Adventist Health Commercial |
$11,722.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,267.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,674.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$26,376.30
|
| Rate for Payer: Cash Price |
$26,376.30
|
| Rate for Payer: Cash Price |
$26,376.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,642.02
|
| Rate for Payer: Dignity Health Senior |
$29,674.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,674.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,282.07
|
| Rate for Payer: Heritage Provider Network Senior |
$36,499.71
|
| Rate for Payer: Humana Medicare |
$29,674.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,373.53
|
| Rate for Payer: IEHP Medicare Advantage |
$29,674.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56,381.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,609.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,653.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,389.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,389.95
|
| Rate for Payer: Multiplan Commercial |
$43,960.50
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,674.56
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
OP
|
$33,857.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906811445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,028.76 |
| Max. Negotiated Rate |
$56,381.66 |
| Rate for Payer: Adventist Health Commercial |
$6,771.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,259.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,674.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,642.02
|
| Rate for Payer: Dignity Health Senior |
$29,674.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,674.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,957.48
|
| Rate for Payer: Heritage Provider Network Senior |
$36,499.71
|
| Rate for Payer: Humana Medicare |
$29,674.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,028.76
|
| Rate for Payer: IEHP Medicare Advantage |
$29,674.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56,381.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,128.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,464.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,389.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,389.95
|
| Rate for Payer: Multiplan Commercial |
$25,392.75
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,674.56
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
OP
|
$41,319.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906820248
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,028.76 |
| Max. Negotiated Rate |
$56,381.66 |
| Rate for Payer: Adventist Health Commercial |
$8,263.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,386.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,674.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$18,593.55
|
| Rate for Payer: Cash Price |
$18,593.55
|
| Rate for Payer: Cash Price |
$18,593.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,642.02
|
| Rate for Payer: Dignity Health Senior |
$29,674.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,674.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,576.46
|
| Rate for Payer: Heritage Provider Network Senior |
$36,499.71
|
| Rate for Payer: Humana Medicare |
$29,674.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,028.76
|
| Rate for Payer: IEHP Medicare Advantage |
$29,674.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56,381.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,478.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,329.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,389.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,389.95
|
| Rate for Payer: Multiplan Commercial |
$30,989.25
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,674.56
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
IP
|
$41,319.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906820248
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$30,989.25 |
| Rate for Payer: Adventist Health Commercial |
$8,263.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,386.15
|
| Rate for Payer: Cash Price |
$18,593.55
|
| Rate for Payer: Cash Price |
$18,593.55
|
| 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 |
$7,478.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,329.75
|
| Rate for Payer: Multiplan Commercial |
$30,989.25
|
|
|
HC EPS COMP W SVT ABLATION
|
Facility
IP
|
$33,857.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
906811445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$25,392.75 |
| Rate for Payer: Adventist Health Commercial |
$6,771.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,259.76
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| 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 |
$6,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,464.25
|
| Rate for Payer: Multiplan Commercial |
$25,392.75
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
OP
|
$38,470.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906820249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,373.14 |
| Max. Negotiated Rate |
$56,381.66 |
| Rate for Payer: Adventist Health Commercial |
$7,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,428.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,674.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$17,311.50
|
| Rate for Payer: Cash Price |
$17,311.50
|
| Rate for Payer: Cash Price |
$17,311.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,642.02
|
| Rate for Payer: Dignity Health Senior |
$29,674.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,674.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,812.93
|
| Rate for Payer: Heritage Provider Network Senior |
$36,499.71
|
| Rate for Payer: Humana Medicare |
$29,674.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,373.14
|
| Rate for Payer: IEHP Medicare Advantage |
$29,674.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56,381.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,963.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,617.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,389.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,389.95
|
| Rate for Payer: Multiplan Commercial |
$28,852.50
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,674.56
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
IP
|
$38,470.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906820249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$28,852.50 |
| Rate for Payer: Adventist Health Commercial |
$7,694.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,428.89
|
| Rate for Payer: Cash Price |
$17,311.50
|
| Rate for Payer: Cash Price |
$17,311.50
|
| 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 |
$6,963.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,617.50
|
| Rate for Payer: Multiplan Commercial |
$28,852.50
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
OP
|
$33,857.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906811446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,373.14 |
| Max. Negotiated Rate |
$56,381.66 |
| Rate for Payer: Adventist Health Commercial |
$6,771.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,259.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,674.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,642.02
|
| Rate for Payer: Dignity Health Senior |
$29,674.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,674.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,957.48
|
| Rate for Payer: Heritage Provider Network Senior |
$36,499.71
|
| Rate for Payer: Humana Medicare |
$29,674.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,373.14
|
| Rate for Payer: IEHP Medicare Advantage |
$29,674.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56,381.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,128.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,464.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,389.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,389.95
|
| Rate for Payer: Multiplan Commercial |
$25,392.75
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,511.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,642.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,674.56
|
|
|
HC EPS COMP W VT ABLATION
|
Facility
IP
|
$33,857.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
906811446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$25,392.75 |
| Rate for Payer: Adventist Health Commercial |
$6,771.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,259.76
|
| Rate for Payer: Cash Price |
$15,235.65
|
| Rate for Payer: Cash Price |
$15,235.65
|
| 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 |
$6,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,464.25
|
| Rate for Payer: Multiplan Commercial |
$25,392.75
|
|
|
HC EPS ESOPHOGEAL ATRIAL RECORD
|
Facility
OP
|
$6,440.00
|
|
|
Service Code
|
CPT 93615
|
| Hospital Charge Code |
906811326
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,424.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$127.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$4,830.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,200.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,200.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC EPS 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: AlphaCare Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$127.92
|
| Rate for Payer: 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
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: AlphaCare Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$145.83
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$145.83
|
| Rate for Payer: 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 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$13,996.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$445.57
|
| Rate for Payer: 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
|
|
