|
HC PACE MED SOLARA W1TR03
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813813
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$20,187.50 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,062.50
|
| Rate for Payer: Cash Price |
$13,062.50
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,048.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,700.00
|
| Rate for Payer: Multiplan Commercial |
$19,000.00
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
|
|
HC PACE MED SOLARA W1TR03
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813813
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$20,187.50 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,062.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,584.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17,527.50
|
| Rate for Payer: Blue Shield of California EPN |
$11,542.50
|
| Rate for Payer: Cash Price |
$13,062.50
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,187.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,187.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,625.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,625.00
|
| Rate for Payer: Multiplan Commercial |
$19,000.00
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Senior |
$20,187.50
|
|
|
HC PACE MED SOLARA W4TR03
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813800
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$20,187.50 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,062.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,584.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17,527.50
|
| Rate for Payer: Blue Shield of California EPN |
$11,542.50
|
| Rate for Payer: Cash Price |
$13,062.50
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,187.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,187.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,625.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,625.00
|
| Rate for Payer: Multiplan Commercial |
$19,000.00
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Senior |
$20,187.50
|
|
|
HC PACE MED SOLARA W4TR03
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813800
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$20,187.50 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,062.50
|
| Rate for Payer: Cash Price |
$13,062.50
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,048.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,700.00
|
| Rate for Payer: Multiplan Commercial |
$19,000.00
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
|
|
HC PACE MED SYNCRA C2TR01
|
Facility
|
OP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813647
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$15,476.80 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,181.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13,437.50
|
| Rate for Payer: Blue Shield of California EPN |
$8,849.09
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,476.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,369.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,745.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,745.60
|
| Rate for Payer: Multiplan Commercial |
$14,566.40
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,924.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,924.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,476.80
|
|
|
HC PACE MED SYNCRA C2TR01
|
Facility
|
IP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813647
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$15,476.80 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,937.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,369.92
|
| Rate for Payer: Multiplan Commercial |
$14,566.40
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
|
|
HC PACE MED VERSA VEDR01
|
Facility
|
IP
|
$8,538.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813581
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,707.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,695.90
|
| Rate for Payer: Cash Price |
$4,695.90
|
| Rate for Payer: Cigna of CA HMO |
$5,976.60
|
| Rate for Payer: Cigna of CA PPO |
$5,976.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,415.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,415.20
|
| Rate for Payer: Galaxy Health WC |
$7,257.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,122.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,252.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.12
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: Networks By Design Commercial |
$4,269.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,257.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,204.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,118.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3,051.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,796.20
|
|
|
HC PACE MED VERSA VEDR01
|
Facility
|
OP
|
$8,538.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813581
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$7,257.30 |
| Rate for Payer: Adventist Health Commercial |
$1,707.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,257.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,695.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,403.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,243.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6,301.04
|
| Rate for Payer: Blue Shield of California EPN |
$4,149.47
|
| Rate for Payer: Cash Price |
$4,695.90
|
| Rate for Payer: Cigna of CA HMO |
$5,976.60
|
| Rate for Payer: Cigna of CA PPO |
$5,976.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,257.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,257.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,257.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,415.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,415.20
|
| Rate for Payer: Galaxy Health WC |
$7,257.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,122.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,976.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,976.60
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: Networks By Design Commercial |
$4,269.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,257.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,122.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,122.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,204.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,118.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3,051.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,796.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,257.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,257.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,257.30
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$26,271.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.61 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,254.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: Cigna of CA HMO |
$16,813.44
|
| Rate for Payer: Cigna of CA PPO |
$19,440.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,951.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13,297.25
|
| Rate for Payer: Galaxy Health WC |
$22,330.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,762.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$486.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,522.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,305.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$21,016.80
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$17,076.15
|
| Rate for Payer: Prime Health Services Commercial |
$22,330.35
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,762.60
|
| 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 |
$13,297.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$26,271.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,254.20 |
| Max. Negotiated Rate |
$22,330.35 |
| Rate for Payer: Adventist Health Commercial |
$5,254.20
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,508.40
|
| Rate for Payer: Galaxy Health WC |
$22,330.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,762.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,522.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,009.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,261.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,305.04
|
| Rate for Payer: Multiplan Commercial |
$21,016.80
|
| Rate for Payer: Networks By Design Commercial |
$17,076.15
|
| Rate for Payer: Prime Health Services Commercial |
$22,330.35
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$27,032.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906811419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.61 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,406.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$14,867.60
|
| Rate for Payer: Cash Price |
$14,867.60
|
| Rate for Payer: Cash Price |
$14,867.60
|
| Rate for Payer: Cigna of CA HMO |
$17,300.48
|
| Rate for Payer: Cigna of CA PPO |
$20,003.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,951.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13,297.25
|
| Rate for Payer: Galaxy Health WC |
$22,977.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,219.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$486.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,030.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,487.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$21,625.60
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$17,570.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,977.20
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,219.20
|
| 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 |
$13,297.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$27,032.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906811419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,406.40 |
| Max. Negotiated Rate |
$22,977.20 |
| Rate for Payer: Adventist Health Commercial |
$5,406.40
|
| Rate for Payer: Cash Price |
$14,867.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,812.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,812.80
|
| Rate for Payer: Galaxy Health WC |
$22,977.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,219.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,030.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,299.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,732.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,487.68
|
| Rate for Payer: Multiplan Commercial |
$21,625.60
|
| Rate for Payer: Networks By Design Commercial |
$17,570.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,977.20
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$30,542.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906820214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,108.40 |
| Max. Negotiated Rate |
$25,960.70 |
| Rate for Payer: Adventist Health Commercial |
$6,108.40
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,216.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,216.80
|
| Rate for Payer: Galaxy Health WC |
$25,960.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18,325.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,371.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,636.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,905.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,330.08
|
| Rate for Payer: Multiplan Commercial |
$24,433.60
|
| Rate for Payer: Networks By Design Commercial |
$19,852.30
|
| Rate for Payer: Prime Health Services Commercial |
$25,960.70
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$31,426.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,285.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$17,284.30
|
| Rate for Payer: Cash Price |
$17,284.30
|
| Rate for Payer: Cash Price |
$17,284.30
|
| Rate for Payer: Cigna of CA HMO |
$20,112.64
|
| Rate for Payer: Cigna of CA PPO |
$23,255.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$26,712.10
|
| Rate for Payer: Global Benefits Group Commercial |
$18,855.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,961.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,542.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$25,140.80
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$20,426.90
|
| Rate for Payer: Prime Health Services Commercial |
$26,712.10
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,855.60
|
| 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 |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$31,426.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,285.20 |
| Max. Negotiated Rate |
$26,712.10 |
| Rate for Payer: Adventist Health Commercial |
$6,285.20
|
| Rate for Payer: Cash Price |
$17,284.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,570.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12,570.40
|
| Rate for Payer: Galaxy Health WC |
$26,712.10
|
| Rate for Payer: Global Benefits Group Commercial |
$18,855.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,961.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,973.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,452.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,542.24
|
| Rate for Payer: Multiplan Commercial |
$25,140.80
|
| Rate for Payer: Networks By Design Commercial |
$20,426.90
|
| Rate for Payer: Prime Health Services Commercial |
$26,712.10
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$30,542.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906820214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,108.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: Cigna of CA HMO |
$19,546.88
|
| Rate for Payer: Cigna of CA PPO |
$22,601.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$25,960.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18,325.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,371.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,330.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$24,433.60
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$19,852.30
|
| Rate for Payer: Prime Health Services Commercial |
$25,960.70
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,325.20
|
| 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 |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$21,596.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906820212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.22 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,319.20
|
| 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 |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: Cigna of CA HMO |
$13,821.44
|
| Rate for Payer: Cigna of CA PPO |
$15,981.04
|
| 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 |
$18,356.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,957.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$467.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,183.04
|
| 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 |
$17,276.80
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$14,037.40
|
| Rate for Payer: Prime Health Services Commercial |
$18,356.60
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,957.60
|
| 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 PACE REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$21,596.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906820212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,319.20 |
| Max. Negotiated Rate |
$18,356.60 |
| Rate for Payer: Adventist Health Commercial |
$4,319.20
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,638.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,638.40
|
| Rate for Payer: Galaxy Health WC |
$18,356.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,957.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,228.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,367.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,183.04
|
| Rate for Payer: Multiplan Commercial |
$17,276.80
|
| Rate for Payer: Networks By Design Commercial |
$14,037.40
|
| Rate for Payer: Prime Health Services Commercial |
$18,356.60
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$22,221.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,444.20 |
| Max. Negotiated Rate |
$18,887.85 |
| Rate for Payer: Adventist Health Commercial |
$4,444.20
|
| Rate for Payer: Cash Price |
$12,221.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,888.40
|
| Rate for Payer: Galaxy Health WC |
$18,887.85
|
| Rate for Payer: Global Benefits Group Commercial |
$13,332.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,821.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,466.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,754.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,333.04
|
| Rate for Payer: Multiplan Commercial |
$17,776.80
|
| Rate for Payer: Networks By Design Commercial |
$14,443.65
|
| Rate for Payer: Prime Health Services Commercial |
$18,887.85
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$22,221.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.22 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,444.20
|
| 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 |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$12,221.55
|
| Rate for Payer: Cash Price |
$12,221.55
|
| Rate for Payer: Cash Price |
$12,221.55
|
| Rate for Payer: Cigna of CA HMO |
$14,221.44
|
| Rate for Payer: Cigna of CA PPO |
$16,443.54
|
| 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 |
$18,887.85
|
| Rate for Payer: Global Benefits Group Commercial |
$13,332.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$467.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,821.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,333.04
|
| 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 |
$17,776.80
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$14,443.65
|
| Rate for Payer: Prime Health Services Commercial |
$18,887.85
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,332.60
|
| 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 PACER GENERATOR REMOVAL
|
Facility
|
IP
|
$9,558.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906811358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,911.60 |
| Max. Negotiated Rate |
$8,124.30 |
| Rate for Payer: Adventist Health Commercial |
$1,911.60
|
| Rate for Payer: Cash Price |
$5,256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,823.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,823.20
|
| Rate for Payer: Galaxy Health WC |
$8,124.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,734.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,375.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,641.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,916.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.92
|
| Rate for Payer: Multiplan Commercial |
$7,646.40
|
| Rate for Payer: Networks By Design Commercial |
$6,212.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,124.30
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
|
IP
|
$9,290.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906820115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,858.00 |
| Max. Negotiated Rate |
$7,896.50 |
| Rate for Payer: Adventist Health Commercial |
$1,858.00
|
| Rate for Payer: Cash Price |
$5,109.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,716.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,716.00
|
| Rate for Payer: Galaxy Health WC |
$7,896.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,574.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,196.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,539.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,750.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,229.60
|
| Rate for Payer: Multiplan Commercial |
$7,432.00
|
| Rate for Payer: Networks By Design Commercial |
$6,038.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,896.50
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
|
OP
|
$9,558.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906811358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$261.44 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,911.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$5,256.90
|
| Rate for Payer: Cash Price |
$5,256.90
|
| Rate for Payer: Cash Price |
$5,256.90
|
| Rate for Payer: Cigna of CA HMO |
$6,117.12
|
| Rate for Payer: Cigna of CA PPO |
$7,072.92
|
| 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 |
$8,124.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,734.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,375.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.92
|
| 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 |
$7,646.40
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$6,212.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,124.30
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,734.80
|
| 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 |
$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 PACER GENERATOR REMOVAL
|
Facility
|
OP
|
$9,290.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906820115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$261.44 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,858.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$5,109.50
|
| Rate for Payer: Cash Price |
$5,109.50
|
| Rate for Payer: Cash Price |
$5,109.50
|
| Rate for Payer: Cigna of CA HMO |
$5,945.60
|
| Rate for Payer: Cigna of CA PPO |
$6,874.60
|
| 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 |
$7,896.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,574.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,196.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,229.60
|
| 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 |
$7,432.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$6,038.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,896.50
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,574.00
|
| 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 |
$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 PACER INSERT/RPL ONLY, DUAL
|
Facility
|
IP
|
$26,727.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
906811359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,345.40 |
| Max. Negotiated Rate |
$22,717.95 |
| Rate for Payer: Adventist Health Commercial |
$5,345.40
|
| Rate for Payer: Cash Price |
$14,699.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,690.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,690.80
|
| Rate for Payer: Galaxy Health WC |
$22,717.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,036.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,826.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,182.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,544.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.48
|
| Rate for Payer: Multiplan Commercial |
$21,381.60
|
| Rate for Payer: Networks By Design Commercial |
$17,372.55
|
| Rate for Payer: Prime Health Services Commercial |
$22,717.95
|
|
