|
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 |
$870.61 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,972.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,126.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,806.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,911.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,132.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$870.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,527.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,286.98
|
| Rate for Payer: TriValley Medical Group Senior |
$5,286.98
|
| 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 |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,097.64
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,256.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,256.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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(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: Aetna of CA Non-Gatekeeper |
$2,140.66
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$3,324.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
906811383
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$11,108.00 |
| Rate for Payer: Adventist Health Commercial |
$664.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,054.23
|
| 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 |
$11,108.00
|
| 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 |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,495.80
|
| 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 Medicare Advantage |
$2,825.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,961.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,057.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,057.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,585.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$601.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$648.34 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,213.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,328.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,653.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,217.26
|
| Rate for Payer: Heritage Provider Network Senior |
$3,264.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,042.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$648.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,919.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.09
|
| 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 |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ICD POCKET REVISION/RELOC
|
Facility
|
IP
|
$3,582.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
906811336
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$648.34 |
| Max. Negotiated Rate |
$2,686.50 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,306.81
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,425.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,425.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$648.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
|
|
HC ICD REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$57,613.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
906811423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$66,017.00 |
| Rate for Payer: Adventist Health Commercial |
$11,522.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35,604.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,608.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$25,925.85
|
| Rate for Payer: Cash Price |
$25,925.85
|
| Rate for Payer: Cash Price |
$25,925.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,448.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,469.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,608.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$28,608.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,662.45
|
| Rate for Payer: Heritage Provider Network Senior |
$35,189.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54,357.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,427.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,900.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,403.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,336.01
|
| Rate for Payer: Multiplan Commercial |
$43,209.75
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$31,469.86
|
| Rate for Payer: TriValley Medical Group Senior |
$31,469.86
|
| 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 |
$42,913.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28,608.96
|
|
|
HC ICD REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$57,613.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
906811423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,427.95 |
| Max. Negotiated Rate |
$43,209.75 |
| Rate for Payer: Adventist Health Commercial |
$11,522.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,102.77
|
| Rate for Payer: Cash Price |
$25,925.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,004.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39,004.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,427.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,403.25
|
| Rate for Payer: Multiplan Commercial |
$43,209.75
|
|
|
HC ICD REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$62,006.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
906811424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,223.09 |
| Max. Negotiated Rate |
$46,504.50 |
| Rate for Payer: Adventist Health Commercial |
$12,401.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39,931.86
|
| Rate for Payer: Cash Price |
$27,902.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$41,978.06
|
| Rate for Payer: Heritage Provider Network Senior |
$41,978.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,223.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,501.50
|
| Rate for Payer: Multiplan Commercial |
$46,504.50
|
|
|
HC ICD REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$62,006.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
906811424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$76,705.51 |
| Rate for Payer: Adventist Health Commercial |
$12,401.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,319.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$27,902.70
|
| Rate for Payer: Cash Price |
$27,902.70
|
| Rate for Payer: Cash Price |
$27,902.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40,303.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,371.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,381.71
|
| Rate for Payer: Heritage Provider Network Senior |
$49,656.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76,705.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,427.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,501.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$46,504.50
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,408.45
|
| Rate for Payer: TriValley Medical Group Senior |
$44,408.45
|
| 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 |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC ICD REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$62,006.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
906811422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$66,017.00 |
| Rate for Payer: Adventist Health Commercial |
$12,401.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,319.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,608.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$27,902.70
|
| Rate for Payer: Cash Price |
$27,902.70
|
| Rate for Payer: Cash Price |
$27,902.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40,303.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,469.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,608.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$28,608.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,381.71
|
| Rate for Payer: Heritage Provider Network Senior |
$35,189.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54,357.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,900.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,501.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,336.01
|
| Rate for Payer: Multiplan Commercial |
$46,504.50
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$31,469.86
|
| Rate for Payer: TriValley Medical Group Senior |
$31,469.86
|
| 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 |
$42,913.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28,608.96
|
|
|
HC ICD REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$62,006.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
906811422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,223.09 |
| Max. Negotiated Rate |
$46,504.50 |
| Rate for Payer: Adventist Health Commercial |
$12,401.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39,931.86
|
| Rate for Payer: Cash Price |
$27,902.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$41,978.06
|
| Rate for Payer: Heritage Provider Network Senior |
$41,978.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,223.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,501.50
|
| Rate for Payer: Multiplan Commercial |
$46,504.50
|
|
|
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 |
$4,054.62
|
| 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 Foundation Hospitals 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
|
OP
|
$6,296.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
906812082
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,259.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,890.93
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,149.26
|
| 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 |
$2,833.20
|
| 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 Medicare Advantage |
$5,351.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,714.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,897.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,897.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,003.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,139.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,574.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,407.20
|
| Rate for Payer: Multiplan Commercial |
$4,722.00
|
| 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 |
$5,351.60
|
| 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
|
$820.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$389.50
|
| Rate for Payer: Blue Shield of California EPN |
$309.96
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$391.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Senior |
$492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC I & D ABSCESS COMPL OR MULT
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
900501001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.58
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$480.07
|
| Rate for Payer: Blue Shield of California EPN |
$384.06
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$511.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.15
|
| Rate for Payer: Heritage Provider Network Senior |
$487.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$375.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$258.05
|
| 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 |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$590.25 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.83
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$511.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.15
|
| Rate for Payer: Heritage Provider Network Senior |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$590.25 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.83
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$590.25 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.83
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
|
|
HC I & D ABSCESS SIMPLE
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
900501000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$373.82
|
| Rate for Payer: Blue Shield of California EPN |
$297.49
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$511.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$375.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Senior |
$472.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC I & D ABSCESS,THROAT INTRAORAL
|
Facility
|
IP
|
$5,338.00
|
|
|
Service Code
|
CPT 42720
|
| Hospital Charge Code |
900501607
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$966.18 |
| Max. Negotiated Rate |
$4,003.50 |
| Rate for Payer: Adventist Health Commercial |
$1,067.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,437.67
|
| Rate for Payer: Cash Price |
$2,402.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,613.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3,613.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$966.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,334.50
|
| Rate for Payer: Multiplan Commercial |
$4,003.50
|
|
