|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
IP
|
$95,129.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906820218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17,218.35 |
| Max. Negotiated Rate |
$71,346.75 |
| Rate for Payer: Adventist Health Commercial |
$19,025.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65,353.62
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$64,402.33
|
| Rate for Payer: Heritage Provider Network Senior |
$64,402.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,218.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,782.25
|
| Rate for Payer: Multiplan Commercial |
$71,346.75
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
OP
|
$95,129.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906820218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.03 |
| Max. Negotiated Rate |
$71,346.75 |
| Rate for Payer: Adventist Health Commercial |
$19,025.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65,353.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,396.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,450.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61,833.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,396.02
|
| Rate for Payer: Dignity Health Senior |
$29,450.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,450.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$58,884.85
|
| Rate for Payer: Heritage Provider Network Senior |
$36,224.64
|
| Rate for Payer: Humana Medicare |
$29,450.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,450.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55,956.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,218.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,782.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,108.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,108.17
|
| Rate for Payer: Multiplan Commercial |
$71,346.75
|
| Rate for Payer: Multiplan WC |
$40,263.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$32,396.02
|
| Rate for Payer: TriValley Medical Group Senior |
$32,396.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,396.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,450.93
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$95,129.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906820255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.27 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$19,025.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65,353.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61,833.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$58,884.85
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,218.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,782.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$71,346.75
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$95,129.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906820255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17,218.35 |
| Max. Negotiated Rate |
$71,346.75 |
| Rate for Payer: Adventist Health Commercial |
$19,025.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65,353.62
|
| Rate for Payer: Cash Price |
$42,808.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$64,402.33
|
| Rate for Payer: Heritage Provider Network Senior |
$64,402.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,218.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,782.25
|
| Rate for Payer: Multiplan Commercial |
$71,346.75
|
|
|
HC ICD INSERT/REPL + DUAL LEADS
|
Facility
|
OP
|
$97,445.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820211
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,396.22 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$19,489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66,944.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63,339.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$60,318.46
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,396.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,637.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,361.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$73,083.75
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC ICD INSERT/REPL + DUAL LEADS
|
Facility
|
IP
|
$97,445.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820211
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17,637.54 |
| Max. Negotiated Rate |
$73,083.75 |
| Rate for Payer: Adventist Health Commercial |
$19,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66,944.72
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$65,970.26
|
| Rate for Payer: Heritage Provider Network Senior |
$65,970.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,637.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,361.25
|
| Rate for Payer: Multiplan Commercial |
$73,083.75
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
IP
|
$93,198.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906811377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,868.84 |
| Max. Negotiated Rate |
$69,898.50 |
| Rate for Payer: Adventist Health Commercial |
$18,639.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,027.03
|
| Rate for Payer: Cash Price |
$41,939.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$63,095.05
|
| Rate for Payer: Heritage Provider Network Senior |
$63,095.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,868.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,299.50
|
| Rate for Payer: Multiplan Commercial |
$69,898.50
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
OP
|
$97,445.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,396.22 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$19,489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66,944.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63,339.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$60,318.46
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,396.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,637.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,361.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$73,083.75
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
IP
|
$97,445.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17,637.54 |
| Max. Negotiated Rate |
$73,083.75 |
| Rate for Payer: Adventist Health Commercial |
$19,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66,944.72
|
| Rate for Payer: Cash Price |
$43,850.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$65,970.26
|
| Rate for Payer: Heritage Provider Network Senior |
$65,970.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,637.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,361.25
|
| Rate for Payer: Multiplan Commercial |
$73,083.75
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
OP
|
$93,198.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906811377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,396.22 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$18,639.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,027.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$41,939.10
|
| Rate for Payer: Cash Price |
$41,939.10
|
| Rate for Payer: Cash Price |
$41,939.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60,578.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$57,689.56
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,396.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,868.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,299.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$69,898.50
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
IP
|
$84,570.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906820124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,307.17 |
| Max. Negotiated Rate |
$63,427.50 |
| Rate for Payer: Adventist Health Commercial |
$16,914.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58,099.59
|
| Rate for Payer: Cash Price |
$38,056.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$57,253.89
|
| Rate for Payer: Heritage Provider Network Senior |
$57,253.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,307.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,142.50
|
| Rate for Payer: Multiplan Commercial |
$63,427.50
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
OP
|
$84,570.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906820124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$598.79 |
| Max. Negotiated Rate |
$63,427.50 |
| Rate for Payer: Adventist Health Commercial |
$16,914.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58,099.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,396.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,450.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$38,056.50
|
| Rate for Payer: Cash Price |
$38,056.50
|
| Rate for Payer: Cash Price |
$38,056.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54,970.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,396.02
|
| Rate for Payer: Dignity Health Senior |
$29,450.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,450.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,348.83
|
| Rate for Payer: Heritage Provider Network Senior |
$36,224.64
|
| Rate for Payer: Humana Medicare |
$29,450.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$598.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,450.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55,956.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,307.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,142.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,108.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,108.17
|
| Rate for Payer: Multiplan Commercial |
$63,427.50
|
| Rate for Payer: Multiplan WC |
$40,263.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$32,396.02
|
| Rate for Payer: TriValley Medical Group Senior |
$32,396.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,396.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,450.93
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
OP
|
$62,924.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906811375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$598.79 |
| Max. Negotiated Rate |
$62,843.00 |
| Rate for Payer: Adventist Health Commercial |
$12,584.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,228.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,396.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,450.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$28,315.80
|
| Rate for Payer: Cash Price |
$28,315.80
|
| Rate for Payer: Cash Price |
$28,315.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40,900.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,396.02
|
| Rate for Payer: Dignity Health Senior |
$29,450.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29,450.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,949.96
|
| Rate for Payer: Heritage Provider Network Senior |
$36,224.64
|
| Rate for Payer: Humana Medicare |
$29,450.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$598.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,450.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55,956.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,389.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,731.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,108.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,108.17
|
| Rate for Payer: Multiplan Commercial |
$47,193.00
|
| Rate for Payer: Multiplan WC |
$40,263.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$32,396.02
|
| Rate for Payer: TriValley Medical Group Senior |
$32,396.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,176.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,396.02
|
| Rate for Payer: Vantage Medical Group Senior |
$29,450.93
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
IP
|
$62,924.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906811375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,389.24 |
| Max. Negotiated Rate |
$47,193.00 |
| Rate for Payer: Adventist Health Commercial |
$12,584.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,228.79
|
| Rate for Payer: Cash Price |
$28,315.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,599.55
|
| Rate for Payer: Heritage Provider Network Senior |
$42,599.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,731.00
|
| Rate for Payer: Multiplan Commercial |
$47,193.00
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906820123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.22 |
| Max. Negotiated Rate |
$4,467.75 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,032.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906820123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,872.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,687.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
IP
|
$12,150.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906811373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,199.15 |
| Max. Negotiated Rate |
$9,112.50 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,225.55
|
| Rate for Payer: Heritage Provider Network Senior |
$8,225.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906811373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,897.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,520.85
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
OP
|
$3,787.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906811383
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: Adventist Health Commercial |
$757.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,601.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,218.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,082.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,840.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,461.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,218.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,218.95
|
| Rate for Payer: Dignity Health Senior |
$3,218.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,461.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,344.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,344.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$754.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,825.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.75
|
| Rate for Payer: Multiplan Commercial |
$2,840.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,218.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,218.95
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
IP
|
$3,787.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906820055
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$685.45 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$757.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,601.67
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.75
|
| Rate for Payer: Multiplan Commercial |
$2,840.25
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
OP
|
$3,787.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906820055
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: Adventist Health Commercial |
$757.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,601.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,218.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,082.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,840.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,461.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,218.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,218.95
|
| Rate for Payer: Dignity Health Senior |
$3,218.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,461.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,344.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,344.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$754.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,825.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.75
|
| Rate for Payer: Multiplan Commercial |
$2,840.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,218.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,218.95
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
IP
|
$3,787.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906811383
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$685.45 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$757.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,601.67
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Cash Price |
$1,704.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.75
|
| Rate for Payer: Multiplan Commercial |
$2,840.25
|
|
|
HC ICD POCKET REVISION/RELOC
|
Facility
|
OP
|
$4,436.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
906820106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$7,103.00 |
| Rate for Payer: Adventist Health Commercial |
$887.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,047.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,883.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,745.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,802.54
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$3,327.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,506.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC ICD POCKET REVISION/RELOC
|
Facility
|
IP
|
$4,436.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
906820106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$802.92 |
| Max. Negotiated Rate |
$3,327.00 |
| Rate for Payer: Adventist Health Commercial |
$887.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,047.53
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,003.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3,003.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.00
|
| Rate for Payer: Multiplan Commercial |
$3,327.00
|
|
|
HC ICD POCKET REVISION/RELOC
|
Facility
|
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
906811336
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$9,112.50 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,897.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,520.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2,802.54
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,506.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
