|
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
|
|
|
HC ICD REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$71,347.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
906820216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.95 |
| Max. Negotiated Rate |
$62,843.00 |
| Rate for Payer: Adventist Health Commercial |
$14,269.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,015.39
|
| 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$32,106.15
|
| Rate for Payer: Cash Price |
$32,106.15
|
| Rate for Payer: Cash Price |
$32,106.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46,375.55
|
| 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 |
$44,163.79
|
| 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 |
$488.95
|
| 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 |
$12,913.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,836.75
|
| 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 |
$53,510.25
|
| 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 REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$72,650.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
906811423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,149.65 |
| Max. Negotiated Rate |
$54,487.50 |
| Rate for Payer: Adventist Health Commercial |
$14,530.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,910.55
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,184.05
|
| Rate for Payer: Heritage Provider Network Senior |
$49,184.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,149.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.50
|
| Rate for Payer: Multiplan Commercial |
$54,487.50
|
|
|
HC ICD REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$72,650.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
906811423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.95 |
| Max. Negotiated Rate |
$62,843.00 |
| Rate for Payer: Adventist Health Commercial |
$14,530.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,910.55
|
| 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47,222.50
|
| 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 |
$44,970.35
|
| 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 |
$488.95
|
| 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 |
$13,149.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.50
|
| 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 |
$54,487.50
|
| 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 REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$71,347.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
906820216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,913.81 |
| Max. Negotiated Rate |
$53,510.25 |
| Rate for Payer: Adventist Health Commercial |
$14,269.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,015.39
|
| Rate for Payer: Cash Price |
$32,106.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,301.92
|
| Rate for Payer: Heritage Provider Network Senior |
$48,301.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,913.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,836.75
|
| Rate for Payer: Multiplan Commercial |
$53,510.25
|
|
|
HC ICD REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$72,650.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
906811424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$14,530.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,910.55
|
| 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47,222.50
|
| 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 |
$44,970.35
|
| 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 |
$507.20
|
| 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 |
$13,149.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.50
|
| 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 |
$54,487.50
|
| 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 REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$72,650.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
906811424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,149.65 |
| Max. Negotiated Rate |
$54,487.50 |
| Rate for Payer: Adventist Health Commercial |
$14,530.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,910.55
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,184.05
|
| Rate for Payer: Heritage Provider Network Senior |
$49,184.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,149.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.50
|
| Rate for Payer: Multiplan Commercial |
$54,487.50
|
|
|
HC ICD REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$95,129.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
906820217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.20 |
| 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| 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 |
$507.20
|
| 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 REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$95,129.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
906820217
|
|
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 REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$72,650.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
906811422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,149.65 |
| Max. Negotiated Rate |
$54,487.50 |
| Rate for Payer: Adventist Health Commercial |
$14,530.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,910.55
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,184.05
|
| Rate for Payer: Heritage Provider Network Senior |
$49,184.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,149.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.50
|
| Rate for Payer: Multiplan Commercial |
$54,487.50
|
|
|
HC ICD REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$99,885.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
906820215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.71 |
| Max. Negotiated Rate |
$74,913.75 |
| Rate for Payer: Adventist Health Commercial |
$19,977.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68,621.00
|
| 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$44,948.25
|
| Rate for Payer: Cash Price |
$44,948.25
|
| Rate for Payer: Cash Price |
$44,948.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64,925.25
|
| 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 |
$61,828.82
|
| 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 |
$470.71
|
| 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 |
$18,079.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,971.25
|
| 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 |
$74,913.75
|
| 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 REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$99,885.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
906820215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,079.18 |
| Max. Negotiated Rate |
$74,913.75 |
| Rate for Payer: Adventist Health Commercial |
$19,977.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68,621.00
|
| Rate for Payer: Cash Price |
$44,948.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$67,622.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,079.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,971.25
|
| Rate for Payer: Multiplan Commercial |
$74,913.75
|
|
|
HC ICD REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$72,650.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
906811422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.71 |
| Max. Negotiated Rate |
$62,843.00 |
| Rate for Payer: Adventist Health Commercial |
$14,530.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,910.55
|
| 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 |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cash Price |
$32,692.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47,222.50
|
| 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 |
$44,970.35
|
| 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 |
$470.71
|
| 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 |
$13,149.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,752.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,162.50
|
| 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 |
$54,487.50
|
| 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 ICE INTRACARDIAC ECHO
|
Facility
|
IP
|
$6,296.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
906812082
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,139.58 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,259.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,325.35
|
| Rate for Payer: Cash Price |
$2,833.20
|
| Rate for Payer: Cash Price |
$2,833.20
|
| 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 |
$1,139.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,574.00
|
| Rate for Payer: Multiplan Commercial |
$4,722.00
|
|
|
HC ICE INTRACARDIAC ECHO
|
Facility
|
IP
|
$8,940.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
906820078
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,618.14 |
| Max. Negotiated Rate |
$6,705.00 |
| Rate for Payer: Adventist Health Commercial |
$1,788.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,141.78
|
| Rate for Payer: Cash Price |
$4,023.00
|
| Rate for Payer: Cash Price |
$4,023.00
|
| 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 |
$1,618.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,235.00
|
| Rate for Payer: Multiplan Commercial |
$6,705.00
|
|
|
HC ICE INTRACARDIAC ECHO
|
Facility
|
OP
|
$8,940.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
906820078
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$116.82 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,788.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,141.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,599.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,917.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,705.00
|
| 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 |
$4,023.00
|
| Rate for Payer: Cash Price |
$4,023.00
|
| Rate for Payer: Cash Price |
$4,023.00
|
| Rate for Payer: Cash Price |
$4,023.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,599.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,599.00
|
| Rate for Payer: Dignity Health Senior |
$7,599.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,811.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,533.86
|
| Rate for Payer: Heritage Provider Network Senior |
$5,533.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,309.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,618.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,235.00
|
| Rate for Payer: Multiplan Commercial |
$6,705.00
|
| 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 |
$7,599.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,599.00
|
|
|
HC ICE INTRACARDIAC ECHO
|
Facility
|
OP
|
$6,296.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
906812082
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$116.82 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,259.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,325.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,351.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,462.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,722.00
|
| 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 |
$2,833.20
|
| Rate for Payer: Cash Price |
$2,833.20
|
| Rate for Payer: Cash Price |
$2,833.20
|
| Rate for Payer: Cash Price |
$2,833.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,092.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,351.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,351.60
|
| Rate for Payer: Dignity Health Senior |
$5,351.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,092.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,897.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,897.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,034.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,139.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,574.00
|
| Rate for Payer: Multiplan Commercial |
$4,722.00
|
| 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 |
$5,351.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,351.60
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$563.25 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.94
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$508.43
|
| Rate for Payer: Heritage Provider Network Senior |
$508.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.75
|
| Rate for Payer: Multiplan Commercial |
$563.25
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$488.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$508.43
|
| Rate for Payer: Heritage Provider Network Senior |
$508.43
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$563.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$272.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.44
|
| Rate for Payer: Heritage Provider Network Senior |
$487.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$447.12
|
| Rate for Payer: Blue Shield of California EPN |
$422.64
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$468.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.68
|
| Rate for Payer: Heritage Provider Network Senior |
$445.68
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$250.14
|
| 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 Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.44
|
| Rate for Payer: Heritage Provider Network Senior |
$487.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$468.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.68
|
| Rate for Payer: Heritage Provider Network Senior |
$307.67
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$275.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.44
|
| Rate for Payer: Heritage Provider Network Senior |
$487.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$468.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.44
|
| Rate for Payer: Heritage Provider Network Senior |
$487.44
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$347.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$240.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
