|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906820121
|
|
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 |
$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 |
$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 |
$9,616.00
|
| 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 |
$104.34
|
| 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 PACER LEAD REMOVE, DUAL A & V
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906820121
|
|
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 PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
OP
|
$5,659.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
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 |
$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 |
$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 |
$9,616.00
|
| 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 |
$431.23
|
| 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 PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
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 |
$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 |
$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 |
$9,616.00
|
| 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 |
$431.23
|
| 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 PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
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 PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
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 PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| 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 |
$9,616.00
|
| 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 |
$498.18
|
| 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 PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$3,582.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
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: Cash Price |
$1,970.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,425.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,425.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| 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 |
$9,616.00
|
| 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 |
$498.18
|
| 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
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$762.73 |
| Max. Negotiated Rate |
$3,160.50 |
| Rate for Payer: Adventist Health Commercial |
$842.80
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,852.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,852.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.50
|
| Rate for Payer: Multiplan Commercial |
$3,160.50
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$26,411.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,780.39 |
| Max. Negotiated Rate |
$19,808.25 |
| Rate for Payer: Adventist Health Commercial |
$5,282.20
|
| Rate for Payer: Cash Price |
$14,526.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,880.25
|
| Rate for Payer: Heritage Provider Network Senior |
$17,880.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,780.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,602.75
|
| Rate for Payer: Multiplan Commercial |
$19,808.25
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$34,598.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,262.24 |
| Max. Negotiated Rate |
$25,948.50 |
| Rate for Payer: Adventist Health Commercial |
$6,919.60
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,422.85
|
| Rate for Payer: Heritage Provider Network Senior |
$23,422.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,262.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,649.50
|
| Rate for Payer: Multiplan Commercial |
$25,948.50
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$26,411.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,264.78 |
| Rate for Payer: Adventist Health Commercial |
$5,282.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,144.36
|
| 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 |
$6,004.00
|
| 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 |
$14,526.05
|
| Rate for Payer: Cash Price |
$14,526.05
|
| Rate for Payer: Cash Price |
$14,526.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,167.15
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,348.41
|
| Rate for Payer: Heritage Provider Network Senior |
$16,355.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$642.93
|
| 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 |
$4,780.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,291.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,602.75
|
| 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 |
$19,808.25
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| 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 PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$34,598.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,948.50 |
| Rate for Payer: Adventist Health Commercial |
$6,919.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,768.83
|
| 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 |
$6,004.00
|
| 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 |
$19,028.90
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,488.70
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,416.16
|
| Rate for Payer: Heritage Provider Network Senior |
$16,355.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$642.93
|
| 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 |
$6,262.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,291.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,649.50
|
| 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 |
$25,948.50
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| 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 STJ ACCENT DR PM2210
|
Facility
|
IP
|
$13,087.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813691
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,368.84 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$2,617.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,282.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,261.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,261.18
|
| Rate for Payer: Cash Price |
$7,198.13
|
| Rate for Payer: Cash Price |
$7,198.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,020.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,067.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,059.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6,059.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,368.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,271.88
|
| Rate for Payer: Multiplan Commercial |
$9,815.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,728.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,333.27
|
|
|
HC PACE STJ ACCENT DR PM2210
|
Facility
|
OP
|
$13,087.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813691
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,368.84 |
| Max. Negotiated Rate |
$11,124.38 |
| Rate for Payer: Adventist Health Commercial |
$2,617.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,282.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,991.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,124.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,198.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,815.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5,261.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,261.18
|
| Rate for Payer: Cash Price |
$7,198.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,020.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,124.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,124.38
|
| Rate for Payer: Dignity Health Senior |
$11,124.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,376.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,059.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6,059.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,242.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,368.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,271.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,161.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,161.25
|
| Rate for Payer: Multiplan Commercial |
$9,815.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,728.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,333.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,124.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,124.38
|
| Rate for Payer: Vantage Medical Group Senior |
$11,124.38
|
|
|
HC PAD REHAB PER SESSION
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
900203668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| 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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$92.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.02
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| 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 |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC PAD REHAB PER SESSION
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
900203668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,661.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$932.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,202.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,563.55
|
| Rate for Payer: Cash Price |
$2,563.55
|
| Rate for Payer: Cash Price |
$2,563.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,029.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,885.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$613.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,495.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$4,661.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.64 |
| Max. Negotiated Rate |
$3,495.75 |
| Rate for Payer: Adventist Health Commercial |
$932.20
|
| Rate for Payer: Cash Price |
$2,563.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,155.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,155.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.25
|
| Rate for Payer: Multiplan Commercial |
$3,495.75
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$668.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$858.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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 |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$596.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.25
|
| Rate for Payer: Heritage Provider Network Senior |
$846.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| 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 |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$653.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Senior |
$855.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.71
|
| Rate for Payer: Heritage Provider Network Senior |
$622.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$479.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$704.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| 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 |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$754.50 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.06
|
| Rate for Payer: Heritage Provider Network Senior |
$681.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
|
|
HC PARAFFIN BATH PT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
905103109
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Senior |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
