|
HC ENTEROSCOPY SUBMCSL INJ
|
Facility
|
OP
|
$3,548.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906765000
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$709.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,192.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,774.71
|
| 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 |
$1,596.60
|
| Rate for Payer: Cash Price |
$1,596.60
|
| Rate for Payer: Cash Price |
$1,596.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,306.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,196.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,692.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,661.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.29
|
| Rate for Payer: Blue Shield of California Commercial |
$20.45
|
| Rate for Payer: Blue Shield of California Commercial |
$20.45
|
| Rate for Payer: Blue Shield of California EPN |
$16.40
|
| Rate for Payer: Blue Shield of California EPN |
$16.40
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.82
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Senior |
$5.79
|
| Rate for Payer: TriValley Medical Group Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.11
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,165.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,752.70
|
| 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 |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,277.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,565.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,168.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,926.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,975.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,722.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,565.96
|
| 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 |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$634.22 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,256.58
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$634.22 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,256.58
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,165.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,752.70
|
| 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 |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,277.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,565.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,168.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,926.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,975.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,722.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,565.96
|
| 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 |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$2,409.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.03 |
| Max. Negotiated Rate |
$1,806.75 |
| Rate for Payer: Adventist Health Commercial |
$481.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,551.40
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,630.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.25
|
| Rate for Payer: Multiplan Commercial |
$1,806.75
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$2,409.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$481.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,488.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,144.28
|
| Rate for Payer: Blue Shield of California EPN |
$910.60
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,565.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,653.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,630.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,149.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$1,806.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,445.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,445.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,234.55
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,234.55
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
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 |
$346.98 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,184.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$910.58
|
| Rate for Payer: Blue Shield of California EPN |
$724.63
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| 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) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$914.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,150.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,150.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,184.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,169.37
|
| Rate for Payer: Blue Shield of California EPN |
$935.50
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,186.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$914.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$907.88
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,184.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$910.58
|
| Rate for Payer: Blue Shield of California EPN |
$724.63
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| 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) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$914.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,150.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,150.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,234.55
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,184.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,169.37
|
| Rate for Payer: Blue Shield of California EPN |
$935.50
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,186.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$914.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$907.88
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,234.55
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC EPIFIX 2X3
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$347.65 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.58
|
| Rate for Payer: Blue Shield of California Commercial |
$249.49
|
| Rate for Payer: Blue Shield of California EPN |
$199.59
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.37
|
| Rate for Payer: Heritage Provider Network Senior |
$189.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$195.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$286.30
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.60
|
| Rate for Payer: TriValley Medical Group Senior |
$163.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.65
|
| Rate for Payer: Vantage Medical Group Senior |
$347.65
|
|
|
HC EPIFIX 2X3
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$306.75 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.40
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.37
|
| Rate for Payer: Heritage Provider Network Senior |
$189.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.42
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,966.40
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$3,806.26
|
| 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 |
$5,158.00
|
| 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 |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| 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 Medicare Advantage |
$5,235.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,633.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,812.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,812.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,937.84
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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: Aetna of CA Non-Gatekeeper |
$3,205.83
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$4,978.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,076.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,235.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,565.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,081.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,926.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,975.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$901.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| 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 |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
