|
HC ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$3,607.50 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,256.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,256.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
IP
|
$90,373.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906820218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,357.51 |
| Max. Negotiated Rate |
$67,779.75 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$61,182.52
|
| Rate for Payer: Heritage Provider Network Senior |
$61,182.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,357.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,593.25
|
| Rate for Payer: Multiplan Commercial |
$67,779.75
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
OP
|
$90,373.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906820218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$67,779.75 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62,086.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58,742.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Senior |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$28,520.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,940.89
|
| Rate for Payer: Heritage Provider Network Senior |
$35,079.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$506.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54,188.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,357.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,798.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,593.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,935.36
|
| Rate for Payer: Multiplan Commercial |
$67,779.75
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$31,372.14
|
| Rate for Payer: TriValley Medical Group Senior |
$31,372.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$90,373.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906820255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$77,401.14 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62,086.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58,742.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Senior |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,737.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,940.89
|
| Rate for Payer: Heritage Provider Network Senior |
$50,107.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77,401.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,357.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,848.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,593.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,329.17
|
| Rate for Payer: Multiplan Commercial |
$67,779.75
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,811.18
|
| Rate for Payer: TriValley Medical Group Senior |
$44,811.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$90,373.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906820255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,357.51 |
| Max. Negotiated Rate |
$67,779.75 |
| Rate for Payer: Adventist Health Commercial |
$18,074.60
|
| Rate for Payer: Cash Price |
$49,705.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$61,182.52
|
| Rate for Payer: Heritage Provider Network Senior |
$61,182.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,357.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,593.25
|
| Rate for Payer: Multiplan Commercial |
$67,779.75
|
|
|
HC ICD INSERT/REPL + DUAL LEADS
|
Facility
|
IP
|
$91,189.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820211
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,505.21 |
| Max. Negotiated Rate |
$68,391.75 |
| Rate for Payer: Adventist Health Commercial |
$18,237.80
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$61,734.95
|
| Rate for Payer: Heritage Provider Network Senior |
$61,734.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,505.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,797.25
|
| Rate for Payer: Multiplan Commercial |
$68,391.75
|
|
|
HC ICD INSERT/REPL + DUAL LEADS
|
Facility
|
OP
|
$91,189.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820211
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$77,401.14 |
| Rate for Payer: Adventist Health Commercial |
$18,237.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62,646.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59,272.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Senior |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,737.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$56,445.99
|
| Rate for Payer: Heritage Provider Network Senior |
$50,107.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,449.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77,401.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,505.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,848.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,797.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,329.17
|
| Rate for Payer: Multiplan Commercial |
$68,391.75
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,811.18
|
| Rate for Payer: TriValley Medical Group Senior |
$44,811.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
IP
|
$81,925.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906811377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,828.42 |
| Max. Negotiated Rate |
$61,443.75 |
| Rate for Payer: Adventist Health Commercial |
$16,385.00
|
| Rate for Payer: Cash Price |
$45,058.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,463.22
|
| Rate for Payer: Heritage Provider Network Senior |
$55,463.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,828.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,481.25
|
| Rate for Payer: Multiplan Commercial |
$61,443.75
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
OP
|
$81,925.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906811377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$77,401.14 |
| Rate for Payer: Adventist Health Commercial |
$16,385.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,282.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$45,058.75
|
| Rate for Payer: Cash Price |
$45,058.75
|
| Rate for Payer: Cash Price |
$45,058.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,251.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Senior |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,737.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,711.57
|
| Rate for Payer: Heritage Provider Network Senior |
$50,107.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,449.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77,401.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,828.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,848.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,481.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,329.17
|
| Rate for Payer: Multiplan Commercial |
$61,443.75
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,811.18
|
| Rate for Payer: TriValley Medical Group Senior |
$44,811.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
OP
|
$91,189.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$77,401.14 |
| Rate for Payer: Adventist Health Commercial |
$18,237.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62,646.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59,272.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Senior |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,737.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$56,445.99
|
| Rate for Payer: Heritage Provider Network Senior |
$50,107.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,449.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77,401.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,505.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,848.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,797.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,329.17
|
| Rate for Payer: Multiplan Commercial |
$68,391.75
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,811.18
|
| Rate for Payer: TriValley Medical Group Senior |
$44,811.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC ICD INSERT/REPOS SINGLE/DBL +LEAD
|
Facility
|
IP
|
$91,189.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906820125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,505.21 |
| Max. Negotiated Rate |
$68,391.75 |
| Rate for Payer: Adventist Health Commercial |
$18,237.80
|
| Rate for Payer: Cash Price |
$50,153.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$61,734.95
|
| Rate for Payer: Heritage Provider Network Senior |
$61,734.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,505.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,797.25
|
| Rate for Payer: Multiplan Commercial |
$68,391.75
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
IP
|
$53,705.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906811375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,720.60 |
| Max. Negotiated Rate |
$40,278.75 |
| Rate for Payer: Adventist Health Commercial |
$10,741.00
|
| Rate for Payer: Cash Price |
$29,537.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,358.29
|
| Rate for Payer: Heritage Provider Network Senior |
$36,358.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,720.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,426.25
|
| Rate for Payer: Multiplan Commercial |
$40,278.75
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
OP
|
$53,705.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906811375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$66,017.00 |
| Rate for Payer: Adventist Health Commercial |
$10,741.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,895.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$29,537.75
|
| Rate for Payer: Cash Price |
$29,537.75
|
| Rate for Payer: Cash Price |
$29,537.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,908.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Senior |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$28,520.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,243.39
|
| Rate for Payer: Heritage Provider Network Senior |
$35,079.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$621.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54,188.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,720.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,798.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,426.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,935.36
|
| Rate for Payer: Multiplan Commercial |
$40,278.75
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$31,372.14
|
| Rate for Payer: TriValley Medical Group Senior |
$31,372.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
IP
|
$80,342.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906820124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,541.90 |
| Max. Negotiated Rate |
$60,256.50 |
| Rate for Payer: Adventist Health Commercial |
$16,068.40
|
| Rate for Payer: Cash Price |
$44,188.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$54,391.53
|
| Rate for Payer: Heritage Provider Network Senior |
$54,391.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,541.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,085.50
|
| Rate for Payer: Multiplan Commercial |
$60,256.50
|
|
|
HC ICD INSERT SINGLE/DBL CHAMBER
|
Facility
|
OP
|
$80,342.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
906820124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$66,017.00 |
| Rate for Payer: Adventist Health Commercial |
$16,068.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55,194.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$44,188.10
|
| Rate for Payer: Cash Price |
$44,188.10
|
| Rate for Payer: Cash Price |
$44,188.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52,222.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Senior |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$28,520.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$35,079.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$621.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54,188.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,541.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,798.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,085.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,935.36
|
| Rate for Payer: Multiplan Commercial |
$60,256.50
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$31,372.14
|
| Rate for Payer: TriValley Medical Group Senior |
$31,372.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906820123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,024.28 |
| Max. Negotiated Rate |
$4,244.25 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,831.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3,831.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,414.75
|
| Rate for Payer: Multiplan Commercial |
$4,244.25
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906811373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,304.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| 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: Cigna of CA HMO/PPO |
$3,126.50
|
| 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 Senior |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,624.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,687.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,785.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,317.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,826.35
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,086.50
|
| Rate for Payer: TriValley Medical Group Senior |
$5,086.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906811373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$3,607.50 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Cash Price |
$2,645.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,256.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,256.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
|
|
HC ICD LEAD REMOVAL, A &/OR V
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
906820123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,887.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| 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: Cigna of CA HMO/PPO |
$3,678.35
|
| 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 Senior |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,624.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,502.92
|
| Rate for Payer: Heritage Provider Network Senior |
$5,687.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,785.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,317.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,414.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,826.35
|
| Rate for Payer: Multiplan Commercial |
$4,244.25
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,086.50
|
| Rate for Payer: TriValley Medical Group Senior |
$5,086.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
IP
|
$3,324.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906811383
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$601.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$664.80
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| 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 |
$601.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Multiplan Commercial |
$2,493.00
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906820055
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$707.71 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$782.00
|
| Rate for Payer: Cash Price |
$2,150.50
|
| Rate for Payer: Cash Price |
$2,150.50
|
| 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 |
$707.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.50
|
| Rate for Payer: Multiplan Commercial |
$2,932.50
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906820055
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,680.00 |
| Rate for Payer: Adventist Health Commercial |
$782.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,686.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,323.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,150.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,932.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,150.50
|
| Rate for Payer: Cash Price |
$2,150.50
|
| Rate for Payer: Cash Price |
$2,150.50
|
| Rate for Payer: Cash Price |
$2,150.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,541.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,323.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,323.50
|
| Rate for Payer: Dignity Health Senior |
$3,323.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,541.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,420.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,420.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$783.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,865.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,737.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,737.00
|
| Rate for Payer: Multiplan Commercial |
$2,932.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,323.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,323.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,323.50
|
|
|
HC ICD LEAD(S) TEST @ IMPLANT
|
Facility
|
OP
|
$3,324.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906811383
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,680.00 |
| Rate for Payer: Adventist Health Commercial |
$664.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,283.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,825.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,828.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,493.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,160.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,825.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,825.40
|
| Rate for Payer: Dignity Health Senior |
$2,825.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,160.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,057.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,057.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$783.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,585.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,326.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,326.80
|
| Rate for Payer: Multiplan Commercial |
$2,493.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,825.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,825.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,825.40
|
|
|
HC ICD POCKET REVISION/RELOC
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
906811336
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,460.83
|
| 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 HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| 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: Cigna of CA HMO/PPO |
$2,328.30
|
| 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 Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,217.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,858.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,416.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,556.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,556.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 ICD POCKET REVISION/RELOC
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
906820106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$842.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,895.02
|
| 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 HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| 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: Cigna of CA HMO/PPO |
$2,739.10
|
| 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 Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,608.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2,858.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,416.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$3,160.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,556.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,556.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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
|
|
