|
HC SUBC THER INFUSION UP TO 1 HR
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
907296369
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC SUBC THER INFUSION UP TO 1 HR
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
907296369
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$278.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: Cigna of CA HMO |
$889.60
|
| Rate for Payer: Cigna of CA PPO |
$1,028.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,181.50
|
| Rate for Payer: Global Benefits Group Commercial |
$834.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$927.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,112.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$903.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,181.50
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$834.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.00
|
| Rate for Payer: United Healthcare All Other HMO |
$695.00
|
| Rate for Payer: United Healthcare HMO Rider |
$695.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$695.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$1,181.50 |
| Rate for Payer: Adventist Health Commercial |
$278.00
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.00
|
| Rate for Payer: EPIC Health Plan Senior |
$556.00
|
| Rate for Payer: Galaxy Health WC |
$1,181.50
|
| Rate for Payer: Global Benefits Group Commercial |
$834.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$927.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$860.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.60
|
| Rate for Payer: Multiplan Commercial |
$1,112.00
|
| Rate for Payer: Networks By Design Commercial |
$903.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,181.50
|
|
|
HC SUB PT/OT CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8993
|
| Hospital Charge Code |
900018315
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8993
|
| Hospital Charge Code |
900018315
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8995
|
| Hospital Charge Code |
900018317
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8995
|
| Hospital Charge Code |
900018317
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8994
|
| Hospital Charge Code |
900018316
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8994
|
| Hospital Charge Code |
900018316
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
IP
|
$22,643.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,528.60 |
| Max. Negotiated Rate |
$19,246.55 |
| Rate for Payer: Adventist Health Commercial |
$4,528.60
|
| Rate for Payer: Cash Price |
$12,453.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,057.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,057.20
|
| Rate for Payer: Galaxy Health WC |
$19,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13,585.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,102.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,626.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,016.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,434.32
|
| Rate for Payer: Multiplan Commercial |
$18,114.40
|
| Rate for Payer: Networks By Design Commercial |
$14,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$19,246.55
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
OP
|
$22,643.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.54 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,528.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$12,453.65
|
| Rate for Payer: Cash Price |
$12,453.65
|
| Rate for Payer: Cash Price |
$12,453.65
|
| Rate for Payer: Cigna of CA HMO |
$14,491.52
|
| Rate for Payer: Cigna of CA PPO |
$16,755.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$19,246.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13,585.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$720.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,102.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,434.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$18,114.40
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$14,717.95
|
| Rate for Payer: Prime Health Services Commercial |
$19,246.55
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,585.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
IP
|
$9,557.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,911.40 |
| Max. Negotiated Rate |
$8,123.45 |
| Rate for Payer: Adventist Health Commercial |
$1,911.40
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,822.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,822.80
|
| Rate for Payer: Galaxy Health WC |
$8,123.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,734.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,374.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,641.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,915.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.68
|
| Rate for Payer: Multiplan Commercial |
$7,645.60
|
| Rate for Payer: Networks By Design Commercial |
$6,212.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,123.45
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
OP
|
$9,557.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.01 |
| Max. Negotiated Rate |
$45,133.00 |
| Rate for Payer: Adventist Health Commercial |
$1,911.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: Cigna of CA HMO |
$6,116.48
|
| Rate for Payer: Cigna of CA PPO |
$7,072.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,123.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,734.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$531.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,374.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,645.60
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$6,212.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,123.45
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,734.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
OP
|
$9,557.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$579.18 |
| Max. Negotiated Rate |
$45,133.00 |
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: Adventist Health Commercial |
$1,911.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: Cigna of CA HMO |
$6,116.48
|
| Rate for Payer: Cigna of CA PPO |
$7,072.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$8,123.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,734.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$579.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,374.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,645.60
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$6,212.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,123.45
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,734.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
IP
|
$9,557.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,911.40 |
| Max. Negotiated Rate |
$8,123.45 |
| Rate for Payer: Adventist Health Commercial |
$1,911.40
|
| Rate for Payer: Cash Price |
$5,256.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,822.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,822.80
|
| Rate for Payer: Galaxy Health WC |
$8,123.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,734.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,374.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,641.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,915.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.68
|
| Rate for Payer: Multiplan Commercial |
$7,645.60
|
| Rate for Payer: Networks By Design Commercial |
$6,212.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,123.45
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$3,096.55 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| Rate for Payer: Multiplan Commercial |
$2,914.40
|
| Rate for Payer: Networks By Design Commercial |
$2,367.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$4,286.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906820278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$857.20 |
| Max. Negotiated Rate |
$3,643.10 |
| Rate for Payer: Adventist Health Commercial |
$857.20
|
| Rate for Payer: Cash Price |
$2,357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,714.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,714.40
|
| Rate for Payer: Galaxy Health WC |
$3,643.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,858.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,632.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,653.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.64
|
| Rate for Payer: Multiplan Commercial |
$3,428.80
|
| Rate for Payer: Networks By Design Commercial |
$2,785.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,643.10
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$2,237.17
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Cigna of CA HMO |
$2,331.52
|
| Rate for Payer: Cigna of CA PPO |
$2,695.82
|
| 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 Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$2,914.40
|
| Rate for Payer: Multiplan WC |
$2,457.69
|
| Rate for Payer: Networks By Design Commercial |
$2,367.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Prime Health Services WC |
$2,432.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,821.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,821.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,821.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,821.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| 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 SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$4,286.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906820278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$857.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$2,632.03
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$2,357.30
|
| Rate for Payer: Cash Price |
$2,357.30
|
| Rate for Payer: Cash Price |
$2,357.30
|
| Rate for Payer: Cigna of CA HMO |
$2,743.04
|
| Rate for Payer: Cigna of CA PPO |
$3,171.64
|
| 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 Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$3,643.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,858.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,632.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$3,428.80
|
| Rate for Payer: Multiplan WC |
$2,457.69
|
| Rate for Payer: Networks By Design Commercial |
$2,785.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,643.10
|
| Rate for Payer: Prime Health Services WC |
$2,432.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,143.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,143.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,143.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,143.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| 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 SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$75,675.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906820275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,135.00 |
| Max. Negotiated Rate |
$64,323.75 |
| Rate for Payer: Adventist Health Commercial |
$15,135.00
|
| Rate for Payer: Cash Price |
$41,621.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30,270.00
|
| Rate for Payer: Galaxy Health WC |
$64,323.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45,405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,475.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,832.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,842.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.00
|
| Rate for Payer: Multiplan Commercial |
$60,540.00
|
| Rate for Payer: Networks By Design Commercial |
$49,188.75
|
| Rate for Payer: Prime Health Services Commercial |
$64,323.75
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$77,865.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,573.00 |
| Max. Negotiated Rate |
$66,185.25 |
| Rate for Payer: Adventist Health Commercial |
$15,573.00
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$31,146.00
|
| Rate for Payer: Galaxy Health WC |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51,935.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,666.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,198.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| Rate for Payer: Multiplan Commercial |
$62,292.00
|
| Rate for Payer: Networks By Design Commercial |
$50,612.25
|
| Rate for Payer: Prime Health Services Commercial |
$66,185.25
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$77,865.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$66,185.25 |
| Rate for Payer: Adventist Health Commercial |
$15,573.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: Cigna of CA HMO |
$49,833.60
|
| Rate for Payer: Cigna of CA PPO |
$57,620.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51,935.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,666.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$62,292.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$50,612.25
|
| Rate for Payer: Prime Health Services Commercial |
$66,185.25
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,719.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$75,675.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906820275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$64,323.75 |
| Rate for Payer: Adventist Health Commercial |
$15,135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$41,621.25
|
| Rate for Payer: Cash Price |
$41,621.25
|
| Rate for Payer: Cash Price |
$41,621.25
|
| Rate for Payer: Cigna of CA HMO |
$48,432.00
|
| Rate for Payer: Cigna of CA PPO |
$55,999.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$64,323.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45,405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,475.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,832.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$60,540.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$49,188.75
|
| Rate for Payer: Prime Health Services Commercial |
$64,323.75
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$77,865.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,573.00 |
| Max. Negotiated Rate |
$66,185.25 |
| Rate for Payer: Adventist Health Commercial |
$15,573.00
|
| Rate for Payer: Cash Price |
$42,825.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$31,146.00
|
| Rate for Payer: Galaxy Health WC |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51,935.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,666.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,198.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| Rate for Payer: Multiplan Commercial |
$62,292.00
|
| Rate for Payer: Networks By Design Commercial |
$50,612.25
|
| Rate for Payer: Prime Health Services Commercial |
$66,185.25
|
|
