|
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 |
$1,928.70
|
| 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 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 |
$35,039.25
|
| 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
|
$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 |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| 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 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 |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| 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
|
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 |
$34,053.75
|
| 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 REMOVE
|
Facility
|
OP
|
$77,865.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
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 |
$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 |
$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 |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| 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 |
$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 |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| 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 |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| 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 |
$62,292.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| 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 |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,719.00
|
| 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 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 |
$35,039.25
|
| 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 REMOVE
|
Facility
|
OP
|
$75,675.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906820276
|
|
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 |
$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 |
$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 |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| 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 |
$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 |
$64,323.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45,405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| 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 |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.00
|
| 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 |
$60,540.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| 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 |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,405.00
|
| 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 SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$75,675.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906820276
|
|
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 |
$34,053.75
|
| 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 REPOS
|
Facility
|
OP
|
$75,675.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906820277
|
|
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 |
$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 |
$6,427.00
|
| 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 |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| 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 |
$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 |
$64,323.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45,405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| 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 |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.00
|
| 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 |
$60,540.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| 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 |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,405.00
|
| 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 SUBSTERN ICD LEAD REPOS
|
Facility
|
OP
|
$77,865.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
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 |
$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 |
$6,427.00
|
| 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 |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| 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 |
$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 |
$66,185.25
|
| Rate for Payer: Global Benefits Group Commercial |
$46,719.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| 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 |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| 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 |
$62,292.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| 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 |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,719.00
|
| 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 SUBSTERN ICD LEAD REPOS
|
Facility
|
IP
|
$77,865.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
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 |
$35,039.25
|
| 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 REPOS
|
Facility
|
IP
|
$75,675.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906820277
|
|
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 |
$34,053.75
|
| 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 REMOVE
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| 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 |
$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 |
$2,546.55
|
| Rate for Payer: Cash Price |
$2,546.55
|
| Rate for Payer: Cash Price |
$2,546.55
|
| Rate for Payer: Cigna of CA HMO |
$3,621.76
|
| Rate for Payer: Cigna of CA PPO |
$4,187.66
|
| 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 |
$4,810.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,395.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,774.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,358.16
|
| 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 |
$4,527.20
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,395.40
|
| 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 SUBSTERN ICD REMOVE
|
Facility
|
OP
|
$5,822.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| 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 |
$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 |
$2,619.90
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cigna of CA HMO |
$3,726.08
|
| Rate for Payer: Cigna of CA PPO |
$4,308.28
|
| 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 |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,883.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.28
|
| 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 |
$4,657.60
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,493.20
|
| 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 SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$5,822.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,164.40 |
| Max. Negotiated Rate |
$4,948.70 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,328.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,328.80
|
| Rate for Payer: Galaxy Health WC |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,883.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,603.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.28
|
| Rate for Payer: Multiplan Commercial |
$4,657.60
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,131.80 |
| Max. Negotiated Rate |
$4,810.15 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Cash Price |
$2,546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,263.60
|
| Rate for Payer: Galaxy Health WC |
$4,810.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,395.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,774.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,502.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,358.16
|
| Rate for Payer: Multiplan Commercial |
$4,527.20
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$77,865.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$15,573.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| 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 |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| Rate for Payer: Cash Price |
$35,039.25
|
| 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 |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,995.54
|
| Rate for Payer: EPIC Health Plan Senior |
$40,737.44
|
| 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 |
$66,809.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| 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 |
$40,737.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,687.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,588.17
|
| Rate for Payer: Multiplan Commercial |
$62,292.00
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| 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 |
$64,245.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,719.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,737.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$75,675.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
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 |
$34,053.75
|
| 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 LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$77,865.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
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 |
$35,039.25
|
| 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 LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$75,675.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$15,135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| 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 |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| Rate for Payer: Cash Price |
$34,053.75
|
| 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 |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,995.54
|
| Rate for Payer: EPIC Health Plan Senior |
$40,737.44
|
| 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 |
$66,809.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| 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 |
$40,737.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,588.17
|
| Rate for Payer: Multiplan Commercial |
$60,540.00
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| 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 |
$64,245.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,737.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.73
|
| Rate for Payer: Blue Shield of California Commercial |
$90.98
|
| Rate for Payer: Blue Shield of California EPN |
$60.11
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.73
|
| Rate for Payer: Blue Shield of California Commercial |
$90.98
|
| Rate for Payer: Blue Shield of California EPN |
$60.11
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
