|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,150.60 |
| Max. Negotiated Rate |
$4,890.05 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,795.96
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,191.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,561.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.72
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.89
|
| Rate for Payer: Blue Shield of California Commercial |
$90.58
|
| Rate for Payer: Blue Shield of California EPN |
$59.79
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.19
|
| Rate for Payer: EPIC Health Plan Senior |
$20.88
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.98
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.97
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Blue Shield of California Commercial |
$109.22
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
OP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$388.09 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.39
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Cigna of CA HMO |
$292.21
|
| Rate for Payer: Cigna of CA PPO |
$337.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$388.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$388.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$388.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.61
|
| Rate for Payer: Multiplan Commercial |
$365.26
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.29
|
| Rate for Payer: United Healthcare All Other HMO |
$228.29
|
| Rate for Payer: United Healthcare HMO Rider |
$228.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.09
|
| Rate for Payer: Vantage Medical Group Senior |
$388.09
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
IP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$388.09 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.58
|
| Rate for Payer: Multiplan Commercial |
$365.26
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
IP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$462.93 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.71
|
| Rate for Payer: Multiplan Commercial |
$435.70
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
OP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$462.93 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.45
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Cigna of CA HMO |
$348.56
|
| Rate for Payer: Cigna of CA PPO |
$403.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$462.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$381.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.23
|
| Rate for Payer: Multiplan Commercial |
$435.70
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.31
|
| Rate for Payer: United Healthcare All Other HMO |
$272.31
|
| Rate for Payer: United Healthcare HMO Rider |
$272.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.93
|
| Rate for Payer: Vantage Medical Group Senior |
$462.93
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$8,715.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,743.00 |
| Max. Negotiated Rate |
$7,407.75 |
| Rate for Payer: Adventist Health Commercial |
$1,743.00
|
| Rate for Payer: Cash Price |
$3,921.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,486.00
|
| Rate for Payer: Galaxy Health WC |
$7,407.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,229.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,812.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,320.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,394.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,091.60
|
| Rate for Payer: Multiplan Commercial |
$6,972.00
|
| Rate for Payer: Networks By Design Commercial |
$5,664.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,407.75
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$8,715.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,743.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,407.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,793.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,536.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,921.75
|
| Rate for Payer: Cash Price |
$3,921.75
|
| Rate for Payer: Cash Price |
$3,921.75
|
| Rate for Payer: Cigna of CA HMO |
$5,577.60
|
| Rate for Payer: Cigna of CA PPO |
$6,449.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,407.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,407.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,407.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,486.00
|
| Rate for Payer: Galaxy Health WC |
$7,407.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,229.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$912.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,812.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,394.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,091.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,100.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,100.50
|
| Rate for Payer: Multiplan Commercial |
$6,972.00
|
| Rate for Payer: Networks By Design Commercial |
$5,664.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,407.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,229.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,229.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,407.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,407.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,407.75
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$7,408.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,481.60 |
| Max. Negotiated Rate |
$6,296.80 |
| Rate for Payer: Adventist Health Commercial |
$1,481.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,963.20
|
| Rate for Payer: Galaxy Health WC |
$6,296.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,444.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,822.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,585.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,777.92
|
| Rate for Payer: Multiplan Commercial |
$5,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,815.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,296.80
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$7,408.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Adventist Health Commercial |
$1,481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,296.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,074.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,556.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cigna of CA HMO |
$4,741.12
|
| Rate for Payer: Cigna of CA PPO |
$5,481.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,296.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,296.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,963.20
|
| Rate for Payer: Galaxy Health WC |
$6,296.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$912.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,585.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,777.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,185.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,185.60
|
| Rate for Payer: Multiplan Commercial |
$5,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,815.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,296.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,296.80
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$5,956.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906820107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.20 |
| Max. Negotiated Rate |
$5,062.60 |
| Rate for Payer: Adventist Health Commercial |
$1,191.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,382.40
|
| Rate for Payer: Galaxy Health WC |
$5,062.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,573.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,972.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,686.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.44
|
| Rate for Payer: Multiplan Commercial |
$4,764.80
|
| Rate for Payer: Networks By Design Commercial |
$3,871.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,062.60
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$6,128.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,225.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,225.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,208.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,370.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,596.00
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cigna of CA HMO |
$3,921.92
|
| Rate for Payer: Cigna of CA PPO |
$4,534.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,208.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,208.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,208.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.20
|
| Rate for Payer: Galaxy Health WC |
$5,208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,676.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,505.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,702.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,793.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,289.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,289.60
|
| Rate for Payer: Multiplan Commercial |
$4,902.40
|
| Rate for Payer: Networks By Design Commercial |
$3,983.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,676.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,208.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,208.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,208.80
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$6,128.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,225.60 |
| Max. Negotiated Rate |
$5,208.80 |
| Rate for Payer: Adventist Health Commercial |
$1,225.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.20
|
| Rate for Payer: Galaxy Health WC |
$5,208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,676.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,334.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,793.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.72
|
| Rate for Payer: Multiplan Commercial |
$4,902.40
|
| Rate for Payer: Networks By Design Commercial |
$3,983.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,208.80
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$5,956.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906820107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,062.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,275.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,467.00
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cigna of CA HMO |
$3,811.84
|
| Rate for Payer: Cigna of CA PPO |
$4,407.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,062.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,062.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,062.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,382.40
|
| Rate for Payer: Galaxy Health WC |
$5,062.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,505.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,972.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,702.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,686.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,169.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,169.20
|
| Rate for Payer: Multiplan Commercial |
$4,764.80
|
| Rate for Payer: Networks By Design Commercial |
$3,871.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,062.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,062.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,062.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,062.60
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906820122
|
|
Hospital Revenue Code
|
361
|
| 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 ICD GEN REMOVE ONLY
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906820122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.07 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$2,822.94
|
| 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) Medi-Cal |
$252.07
|
| 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 |
$285.08
|
| 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 ICD GEN REMOVE ONLY
|
Facility
|
OP
|
$5,822.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.07 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$2,822.94
|
| 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) Medi-Cal |
$252.07
|
| 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 |
$285.08
|
| 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 ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$5,822.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| 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 ICD INSERT EXIST DUAL LEADS
|
Facility
|
IP
|
$90,373.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906820218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,074.60 |
| Max. Negotiated Rate |
$76,817.05 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36,149.20
|
| Rate for Payer: Galaxy Health WC |
$76,817.05
|
| Rate for Payer: Global Benefits Group Commercial |
$54,223.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60,278.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,432.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,940.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,689.52
|
| Rate for Payer: Multiplan Commercial |
$72,298.40
|
| Rate for Payer: Networks By Design Commercial |
$58,742.45
|
| Rate for Payer: Prime Health Services Commercial |
$76,817.05
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
IP
|
$92,988.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906811425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,597.60 |
| Max. Negotiated Rate |
$79,039.80 |
| Rate for Payer: Adventist Health Commercial |
$18,597.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37,195.20
|
| Rate for Payer: Galaxy Health WC |
$79,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55,792.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,023.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,428.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,559.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,317.12
|
| Rate for Payer: Multiplan Commercial |
$74,390.40
|
| Rate for Payer: Networks By Design Commercial |
$60,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$79,039.80
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
OP
|
$92,988.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906811425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.39 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$18,597.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cigna of CA HMO |
$59,512.32
|
| Rate for Payer: Cigna of CA PPO |
$68,811.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,502.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28,520.13
|
| Rate for Payer: Galaxy Health WC |
$79,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55,792.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,773.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,023.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,520.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,317.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,216.97
|
| Rate for Payer: Multiplan Commercial |
$74,390.40
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: Networks By Design Commercial |
$60,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$79,039.80
|
| Rate for Payer: Prime Health Services WC |
$44,978.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55,792.80
|
| 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 |
$28,520.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
OP
|
$90,373.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906820218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.39 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: Cigna of CA HMO |
$57,838.72
|
| Rate for Payer: Cigna of CA PPO |
$66,876.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,502.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28,520.13
|
| Rate for Payer: Galaxy Health WC |
$76,817.05
|
| Rate for Payer: Global Benefits Group Commercial |
$54,223.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,773.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60,278.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,520.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,689.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,216.97
|
| Rate for Payer: Multiplan Commercial |
$72,298.40
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: Networks By Design Commercial |
$58,742.45
|
| Rate for Payer: Prime Health Services Commercial |
$76,817.05
|
| Rate for Payer: Prime Health Services WC |
$44,978.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54,223.80
|
| 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 |
$28,520.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$90,373.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906820255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,074.60 |
| Max. Negotiated Rate |
$76,817.05 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36,149.20
|
| Rate for Payer: Galaxy Health WC |
$76,817.05
|
| Rate for Payer: Global Benefits Group Commercial |
$54,223.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60,278.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,432.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,940.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,689.52
|
| Rate for Payer: Multiplan Commercial |
$72,298.40
|
| Rate for Payer: Networks By Design Commercial |
$58,742.45
|
| Rate for Payer: Prime Health Services Commercial |
$76,817.05
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$90,373.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906820255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$545.41 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$45,133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: Cash Price |
$40,667.85
|
| Rate for Payer: Cigna of CA HMO |
$57,838.72
|
| Rate for Payer: Cigna of CA PPO |
$66,876.02
|
| 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 |
$76,817.05
|
| Rate for Payer: Global Benefits Group Commercial |
$54,223.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$66,809.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$545.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60,278.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,737.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,689.52
|
| 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 |
$72,298.40
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: Networks By Design Commercial |
$58,742.45
|
| Rate for Payer: Prime Health Services Commercial |
$76,817.05
|
| Rate for Payer: Prime Health Services WC |
$64,245.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54,223.80
|
| 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
|
|
