|
HC PACER INSERT/RPL, WITH A-LEAD
|
Facility
|
OP
|
$28,184.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
906820108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,636.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$15,501.20
|
| Rate for Payer: Cash Price |
$15,501.20
|
| Rate for Payer: Cash Price |
$15,501.20
|
| Rate for Payer: Central Health Plan Commercial |
$22,547.20
|
| Rate for Payer: Cigna of CA HMO |
$18,037.76
|
| Rate for Payer: Cigna of CA PPO |
$20,856.16
|
| 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 |
$23,956.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,910.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,365.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,798.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,636.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$21,138.00
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$18,319.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$23,956.40
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,910.40
|
| 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 PACER INSERT/RPL, WITH V-LEAD
|
Facility
|
OP
|
$25,215.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
906811351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,043.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$13,868.25
|
| Rate for Payer: Cash Price |
$13,868.25
|
| Rate for Payer: Cash Price |
$13,868.25
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: Cigna of CA HMO |
$16,137.60
|
| Rate for Payer: Cigna of CA PPO |
$18,659.10
|
| 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 |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PACER INSERT/RPL, WITH V-LEAD
|
Facility
|
IP
|
$29,665.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
906820109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,933.00 |
| Max. Negotiated Rate |
$26,698.50 |
| Rate for Payer: Adventist Health Commercial |
$5,933.00
|
| Rate for Payer: Cash Price |
$16,315.75
|
| Rate for Payer: Central Health Plan Commercial |
$23,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,866.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,866.00
|
| Rate for Payer: Galaxy Health WC |
$25,215.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17,799.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,698.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,302.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,362.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,933.00
|
| Rate for Payer: Multiplan Commercial |
$22,248.75
|
| Rate for Payer: Networks By Design Commercial |
$19,282.25
|
| Rate for Payer: Prime Health Services Commercial |
$25,215.25
|
|
|
HC PACER INSERT/RPL, WITH V-LEAD
|
Facility
|
OP
|
$29,665.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
906820109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,933.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$16,315.75
|
| Rate for Payer: Cash Price |
$16,315.75
|
| Rate for Payer: Cash Price |
$16,315.75
|
| Rate for Payer: Central Health Plan Commercial |
$23,732.00
|
| Rate for Payer: Cigna of CA HMO |
$18,985.60
|
| Rate for Payer: Cigna of CA PPO |
$21,952.10
|
| 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 |
$25,215.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17,799.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,698.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,786.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,933.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$22,248.75
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$19,282.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$25,215.25
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,799.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PACER INSERT/RPL, WITH V-LEAD
|
Facility
|
IP
|
$25,215.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
906811351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,043.00 |
| Max. Negotiated Rate |
$22,693.50 |
| Rate for Payer: Adventist Health Commercial |
$5,043.00
|
| Rate for Payer: Cash Price |
$13,868.25
|
| Rate for Payer: Central Health Plan Commercial |
$20,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,086.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,086.00
|
| Rate for Payer: Galaxy Health WC |
$21,432.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,693.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,818.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,606.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Multiplan Commercial |
$18,911.25
|
| Rate for Payer: Networks By Design Commercial |
$16,389.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,432.75
|
|
|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906820121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,527.20
|
| 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: Health Management Network EPO/PPO |
$5,093.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,774.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$4,244.25
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| 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 PACER LEAD REMOVE, DUAL A & V
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906811364
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: Cigna of CA HMO |
$3,078.40
|
| Rate for Payer: Cigna of CA PPO |
$3,559.40
|
| 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 |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,208.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,886.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906811364
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$962.00 |
| Max. Negotiated Rate |
$4,329.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,924.00
|
| Rate for Payer: Galaxy Health WC |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,208.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,832.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,977.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
|
|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906820121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,131.80 |
| Max. Negotiated Rate |
$5,093.10 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,527.20
|
| 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: Health Management Network EPO/PPO |
$5,093.10
|
| 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 |
$1,131.80
|
| Rate for Payer: Multiplan Commercial |
$4,244.25
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,131.80 |
| Max. Negotiated Rate |
$5,093.10 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,527.20
|
| 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: Health Management Network EPO/PPO |
$5,093.10
|
| 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 |
$1,131.80
|
| Rate for Payer: Multiplan Commercial |
$4,244.25
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.85 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,527.20
|
| 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: Health Management Network EPO/PPO |
$5,093.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$457.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,774.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$4,244.25
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| 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 PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$962.00 |
| Max. Negotiated Rate |
$4,329.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,924.00
|
| Rate for Payer: Galaxy Health WC |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,208.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,832.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,977.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.85 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: Cigna of CA HMO |
$3,078.40
|
| Rate for Payer: Cigna of CA PPO |
$3,559.40
|
| 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 |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$457.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,208.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,886.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.93 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,865.60
|
| Rate for Payer: Cigna of CA HMO |
$2,292.48
|
| Rate for Payer: Cigna of CA PPO |
$2,650.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,044.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,149.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,223.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$528.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,389.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,328.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$3,044.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,149.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.93 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$842.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,371.20
|
| Rate for Payer: Cigna of CA HMO |
$2,696.96
|
| Rate for Payer: Cigna of CA PPO |
$3,118.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,581.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,528.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,792.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$528.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,810.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,160.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,739.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$3,581.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,528.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$3,582.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$716.40 |
| Max. Negotiated Rate |
$3,223.80 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,865.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.80
|
| Rate for Payer: Galaxy Health WC |
$3,044.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,149.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,223.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,389.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,364.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,217.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.40
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
| Rate for Payer: Networks By Design Commercial |
$2,328.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,044.70
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$842.80 |
| Max. Negotiated Rate |
$3,792.60 |
| Rate for Payer: Adventist Health Commercial |
$842.80
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,685.60
|
| Rate for Payer: Galaxy Health WC |
$3,581.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,528.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,792.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,810.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,605.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,608.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.80
|
| Rate for Payer: Multiplan Commercial |
$3,160.50
|
| Rate for Payer: Networks By Design Commercial |
$2,739.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,581.90
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$34,598.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$682.62 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$6,919.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Central Health Plan Commercial |
$27,678.40
|
| Rate for Payer: Cigna of CA HMO |
$22,142.72
|
| Rate for Payer: Cigna of CA PPO |
$25,602.52
|
| 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 |
$29,408.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,138.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,076.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,919.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$25,948.50
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$22,488.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$29,408.30
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,758.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| 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 PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$29,408.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,881.60 |
| Max. Negotiated Rate |
$26,467.20 |
| Rate for Payer: Adventist Health Commercial |
$5,881.60
|
| Rate for Payer: Cash Price |
$16,174.40
|
| Rate for Payer: Central Health Plan Commercial |
$23,526.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,763.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,763.20
|
| Rate for Payer: Galaxy Health WC |
$24,996.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,644.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,467.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,615.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,204.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,203.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,881.60
|
| Rate for Payer: Multiplan Commercial |
$22,056.00
|
| Rate for Payer: Networks By Design Commercial |
$19,115.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,996.80
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$34,598.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,919.60 |
| Max. Negotiated Rate |
$31,138.20 |
| Rate for Payer: Adventist Health Commercial |
$6,919.60
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Central Health Plan Commercial |
$27,678.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,839.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13,839.20
|
| Rate for Payer: Galaxy Health WC |
$29,408.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,138.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,076.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,181.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,416.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,919.60
|
| Rate for Payer: Multiplan Commercial |
$25,948.50
|
| Rate for Payer: Networks By Design Commercial |
$22,488.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,408.30
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$29,408.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$682.62 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$5,881.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$16,174.40
|
| Rate for Payer: Cash Price |
$16,174.40
|
| Rate for Payer: Cash Price |
$16,174.40
|
| Rate for Payer: Central Health Plan Commercial |
$23,526.40
|
| Rate for Payer: Cigna of CA HMO |
$18,821.12
|
| Rate for Payer: Cigna of CA PPO |
$21,761.92
|
| 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 |
$24,996.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,644.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,467.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,615.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,881.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$22,056.00
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$19,115.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$24,996.80
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,644.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| 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 ST J ALLURE QUADRA PM3242
|
Facility
|
IP
|
$16,270.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813746
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,254.00 |
| Max. Negotiated Rate |
$14,643.00 |
| Rate for Payer: Adventist Health Commercial |
$3,254.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,576.71
|
| Rate for Payer: Blue Shield of California EPN |
$8,200.08
|
| Rate for Payer: Cash Price |
$8,948.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,016.00
|
| Rate for Payer: Cigna of CA HMO |
$11,389.00
|
| Rate for Payer: Cigna of CA PPO |
$11,389.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,508.00
|
| Rate for Payer: Galaxy Health WC |
$13,829.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,762.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,643.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,852.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,198.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,071.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,254.00
|
| Rate for Payer: Multiplan Commercial |
$12,202.50
|
| Rate for Payer: Networks By Design Commercial |
$8,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,829.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,106.13
|
| Rate for Payer: United Healthcare All Other HMO |
$5,943.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5,814.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,328.43
|
|
|
HC PACE ST J ALLURE QUADRA PM3242
|
Facility
|
OP
|
$16,270.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813746
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,254.00 |
| Max. Negotiated Rate |
$14,643.00 |
| Rate for Payer: Adventist Health Commercial |
$3,254.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,829.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,948.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,202.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,877.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,555.37
|
| Rate for Payer: Blue Shield of California Commercial |
$12,576.71
|
| Rate for Payer: Blue Shield of California EPN |
$8,200.08
|
| Rate for Payer: Cash Price |
$8,948.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,016.00
|
| Rate for Payer: Cigna of CA HMO |
$11,389.00
|
| Rate for Payer: Cigna of CA PPO |
$11,389.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,829.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,829.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,829.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,508.00
|
| Rate for Payer: Galaxy Health WC |
$13,829.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,762.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,643.00
|
| Rate for Payer: InnovAge PACE Commercial |
$8,135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,852.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,071.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,254.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,389.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,389.00
|
| Rate for Payer: Multiplan Commercial |
$12,202.50
|
| Rate for Payer: Networks By Design Commercial |
$8,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,829.50
|
| Rate for Payer: Riverside University Health System MISP |
$6,508.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,762.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,762.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,106.13
|
| Rate for Payer: United Healthcare All Other HMO |
$5,943.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5,814.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,328.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,829.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,829.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,829.50
|
|
|
HC PACE STJ ALLURE RF PM3222
|
Facility
|
IP
|
$13,895.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813775
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,779.00 |
| Max. Negotiated Rate |
$12,505.50 |
| Rate for Payer: Adventist Health Commercial |
$2,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,740.83
|
| Rate for Payer: Blue Shield of California EPN |
$7,003.08
|
| Rate for Payer: Cash Price |
$7,642.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,116.00
|
| Rate for Payer: Cigna of CA HMO |
$9,726.50
|
| Rate for Payer: Cigna of CA PPO |
$9,726.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,558.00
|
| Rate for Payer: Galaxy Health WC |
$11,810.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,505.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,267.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,293.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,601.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,779.00
|
| Rate for Payer: Multiplan Commercial |
$10,421.25
|
| Rate for Payer: Networks By Design Commercial |
$6,947.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,810.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,214.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,075.84
|
| Rate for Payer: United Healthcare HMO Rider |
$4,966.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,550.61
|
|
|
HC PACE STJ ALLURE RF PM3222
|
Facility
|
OP
|
$13,895.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813775
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,779.00 |
| Max. Negotiated Rate |
$12,505.50 |
| Rate for Payer: Adventist Health Commercial |
$2,779.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,642.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,421.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,727.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,160.53
|
| Rate for Payer: Blue Shield of California Commercial |
$10,740.83
|
| Rate for Payer: Blue Shield of California EPN |
$7,003.08
|
| Rate for Payer: Cash Price |
$7,642.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,116.00
|
| Rate for Payer: Cigna of CA HMO |
$9,726.50
|
| Rate for Payer: Cigna of CA PPO |
$9,726.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,810.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,810.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,558.00
|
| Rate for Payer: Galaxy Health WC |
$11,810.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,505.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6,947.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,267.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,601.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,779.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,726.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,726.50
|
| Rate for Payer: Multiplan Commercial |
$10,421.25
|
| Rate for Payer: Networks By Design Commercial |
$6,947.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,810.75
|
| Rate for Payer: Riverside University Health System MISP |
$5,558.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,337.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,214.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,075.84
|
| Rate for Payer: United Healthcare HMO Rider |
$4,966.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,550.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,810.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,810.75
|
|
