|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
IP
|
$34,181.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$6,186.76 |
| Max. Negotiated Rate |
$25,635.75 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Cash Price |
$18,799.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,140.54
|
| Rate for Payer: Heritage Provider Network Senior |
$23,140.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,186.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,545.25
|
| Rate for Payer: Multiplan Commercial |
$25,635.75
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
OP
|
$34,181.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$851.50 |
| Max. Negotiated Rate |
$29,053.85 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,269.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,482.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,799.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,635.75
|
| Rate for Payer: Blue Shield of California Commercial |
$20,850.41
|
| Rate for Payer: Blue Shield of California EPN |
$16,680.33
|
| Rate for Payer: Cash Price |
$18,799.55
|
| Rate for Payer: Cash Price |
$18,799.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,217.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,053.85
|
| Rate for Payer: Dignity Health Senior |
$29,053.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,217.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,158.04
|
| Rate for Payer: Heritage Provider Network Senior |
$21,158.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$851.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,304.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,186.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,545.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,926.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,926.70
|
| Rate for Payer: Multiplan Commercial |
$25,635.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,090.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17,090.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,053.85
|
| Rate for Payer: Vantage Medical Group Senior |
$29,053.85
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,071.88 |
| Max. Negotiated Rate |
$4,441.50 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,197.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,009.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4,009.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,071.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,480.50
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,139.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,960.77
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$159.05 |
| Max. Negotiated Rate |
$4,441.50 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,165.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,068.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,889.94
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,849.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.03
|
| Rate for Payer: Dignity Health Senior |
$197.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,790.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$179.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,665.72
|
| Rate for Payer: Heritage Provider Network Senior |
$3,665.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$179.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,824.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,071.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,480.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$225.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$225.69
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$197.03
|
| Rate for Payer: TriValley Medical Group Senior |
$179.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,139.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,960.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Vantage Medical Group Senior |
$197.03
|
|
|
HC PACE B/S VITALIO DR K273
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813736
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,868.83 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,956.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,150.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,150.65
|
| Rate for Payer: Cash Price |
$5,678.75
|
| Rate for Payer: Cash Price |
$5,678.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,749.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,575.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,780.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,780.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.25
|
| Rate for Payer: Multiplan Commercial |
$7,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,730.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,418.61
|
|
|
HC PACE B/S VITALIO DR K273
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813736
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,868.83 |
| Max. Negotiated Rate |
$8,776.25 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,956.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,093.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,678.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,743.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,150.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,150.65
|
| Rate for Payer: Cash Price |
$5,678.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,749.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,776.25
|
| Rate for Payer: Dignity Health Senior |
$8,776.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,608.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,780.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,780.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,925.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,227.50
|
| Rate for Payer: Multiplan Commercial |
$7,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,730.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,418.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,776.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,776.25
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$25,976.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,701.66 |
| Max. Negotiated Rate |
$19,482.00 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,585.75
|
| Rate for Payer: Heritage Provider Network Senior |
$17,585.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,701.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,494.00
|
| Rate for Payer: Multiplan Commercial |
$19,482.00
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$25,976.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,845.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| 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 |
$14,286.80
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,884.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,079.14
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,701.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,494.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$19,482.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE MED CONSULTA CRT C4TR01
|
Facility
|
IP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813739
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,295.65 |
| Max. Negotiated Rate |
$13,656.00 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,739.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,319.62
|
| Rate for Payer: Blue Shield of California EPN |
$7,319.62
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,375.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,832.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,430.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,295.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,552.00
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,578.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,028.67
|
|
|
HC PACE MED CONSULTA CRT C4TR01
|
Facility
|
OP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813739
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,295.65 |
| Max. Negotiated Rate |
$15,476.80 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,739.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,508.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,319.62
|
| Rate for Payer: Blue Shield of California EPN |
$7,319.62
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,375.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,476.80
|
| Rate for Payer: Dignity Health Senior |
$15,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,653.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,430.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,685.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,295.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,745.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,745.60
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,578.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,028.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,476.80
|
|
|
HC PACE MED VIVA CRT C6TR01
|
Facility
|
IP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813738
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,295.65 |
| Max. Negotiated Rate |
$13,656.00 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,739.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,319.62
|
| Rate for Payer: Blue Shield of California EPN |
$7,319.62
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,375.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,832.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,430.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,295.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,552.00
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,578.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,028.67
|
|
|
HC PACE MED VIVA CRT C6TR01
|
Facility
|
OP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813738
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,295.65 |
| Max. Negotiated Rate |
$15,476.80 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,739.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,508.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,319.62
|
| Rate for Payer: Blue Shield of California EPN |
$7,319.62
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,375.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,476.80
|
| Rate for Payer: Dignity Health Senior |
$15,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,653.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,430.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,685.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,295.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,745.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,745.60
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,578.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,028.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,476.80
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$21,339.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906811419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,264.78 |
| Rate for Payer: Adventist Health Commercial |
$4,267.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,659.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$11,736.45
|
| Rate for Payer: Cash Price |
$11,736.45
|
| Rate for Payer: Cash Price |
$11,736.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,870.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Senior |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,208.84
|
| Rate for Payer: Heritage Provider Network Senior |
$16,355.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,264.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,862.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,291.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,334.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,754.53
|
| Rate for Payer: Multiplan Commercial |
$16,004.25
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,626.98
|
| Rate for Payer: TriValley Medical Group Senior |
$14,626.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$21,339.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906811419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,862.36 |
| Max. Negotiated Rate |
$16,004.25 |
| Rate for Payer: Adventist Health Commercial |
$4,267.80
|
| Rate for Payer: Cash Price |
$11,736.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,446.50
|
| Rate for Payer: Heritage Provider Network Senior |
$14,446.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,862.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,334.75
|
| Rate for Payer: Multiplan Commercial |
$16,004.25
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$26,271.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,755.05 |
| Max. Negotiated Rate |
$19,703.25 |
| Rate for Payer: Adventist Health Commercial |
$5,254.20
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,785.47
|
| Rate for Payer: Heritage Provider Network Senior |
$17,785.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,755.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,567.75
|
| Rate for Payer: Multiplan Commercial |
$19,703.25
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
OP
|
$26,271.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,264.78 |
| Rate for Payer: Adventist Health Commercial |
$5,254.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,048.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$14,449.05
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: Cash Price |
$14,449.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,076.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Senior |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,261.75
|
| Rate for Payer: Heritage Provider Network Senior |
$16,355.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,264.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,755.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,291.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,567.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,754.53
|
| Rate for Payer: Multiplan Commercial |
$19,703.25
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,626.98
|
| Rate for Payer: TriValley Medical Group Senior |
$14,626.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$22,058.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,992.50 |
| Max. Negotiated Rate |
$16,543.50 |
| Rate for Payer: Adventist Health Commercial |
$4,411.60
|
| Rate for Payer: Cash Price |
$12,131.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,933.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,933.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,514.50
|
| Rate for Payer: Multiplan Commercial |
$16,543.50
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
IP
|
$30,542.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906820214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,528.10 |
| Max. Negotiated Rate |
$22,906.50 |
| Rate for Payer: Adventist Health Commercial |
$6,108.40
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,676.93
|
| Rate for Payer: Heritage Provider Network Senior |
$20,676.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,528.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,635.50
|
| Rate for Payer: Multiplan Commercial |
$22,906.50
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$22,058.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$4,411.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,153.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| 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 |
$12,131.90
|
| Rate for Payer: Cash Price |
$12,131.90
|
| Rate for Payer: Cash Price |
$12,131.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,337.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,653.90
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,514.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$16,543.50
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
|
OP
|
$30,542.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906820214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$6,108.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,982.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| 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 |
$16,798.10
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: Cash Price |
$16,798.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,852.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,905.50
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,528.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,635.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$22,906.50
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$18,357.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,322.62 |
| Max. Negotiated Rate |
$13,767.75 |
| Rate for Payer: Adventist Health Commercial |
$3,671.40
|
| Rate for Payer: Cash Price |
$10,096.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,427.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12,427.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,589.25
|
| Rate for Payer: Multiplan Commercial |
$13,767.75
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$18,357.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$3,671.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,611.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| 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 |
$10,096.35
|
| Rate for Payer: Cash Price |
$10,096.35
|
| Rate for Payer: Cash Price |
$10,096.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,932.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,362.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$450.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,322.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,589.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$13,767.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
OP
|
$21,596.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906820212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$4,319.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,836.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| 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 |
$11,877.80
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,037.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,367.92
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$450.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,908.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,399.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$16,197.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
|
IP
|
$21,596.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906820212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,908.88 |
| Max. Negotiated Rate |
$16,197.00 |
| Rate for Payer: Adventist Health Commercial |
$4,319.20
|
| Rate for Payer: Cash Price |
$11,877.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,620.49
|
| Rate for Payer: Heritage Provider Network Senior |
$14,620.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,908.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,399.00
|
| Rate for Payer: Multiplan Commercial |
$16,197.00
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
|
IP
|
$8,296.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906811358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,501.58 |
| Max. Negotiated Rate |
$6,222.00 |
| Rate for Payer: Adventist Health Commercial |
$1,659.20
|
| Rate for Payer: Cash Price |
$4,562.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,616.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,616.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,501.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,074.00
|
| Rate for Payer: Multiplan Commercial |
$6,222.00
|
|
